Long-term semi-permanent catheter use for the palliation of malignant ascites
ABSTRACT Malignant ascites is a common complication of advanced or recurrent ovarian cancer and multiple other neoplasms, causing significant patient morbidity as well as a large treatment obstacle for the physician. While multiple methods of peritoneal drainage have been reported, including large volume therapeutic paracentesis, peritoneogastric, peritoneourinary, and peritoneovenous shunting procedures, peritoneal port-a-catheter placement and hemodialysis catheter drainage, all have their associated limitations and adverse effects.
We report off label semi-permanent catheter placement in a patient for treatment of malignant ascites that functioned effectively with drainage of 2 l daily for approximately 18 months, the longest reported use in the literature.
Long-term semi-permanent catheter use is a potentially valuable modality for the palliation of malignant ascites.
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ABSTRACT: The development of a pleural effusion or ascites in patients with underlying malignancy typically heralds end-stage disease and often results in a significant reduction in the patient&'s quality of life. The goal of treatment is the safe and effective palliation of symptoms with minimal inconvenience to the patient. Malignant fluid collections in the chest and abdomen are amenable to percutaneous management with either intermittent thoracentesis or paracentesis or by placement of temporary or permanent drainage catheters.Seminars in Interventional Radiology 12/2007; 24(4):398-408. DOI:10.1055/s-2007-992328
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ABSTRACT: Pleural or peritoneal effusions (ascites) are frequent in terminal stage malignancies. Medical management may be hazardous. A 60-year-old man with metastatic malignant melanoma presented refractory ascites as well as bilateral pleural effusions. After failure of the medical treatment, bilateral pleural aspiration and paracentesis became necessary two to three times a week. A multi perforated 15F silicone catheter connected with a subcutaneous port was implanted in peritoneal and both pleural cavities surgically under general anesthesia. Leakage around the catheter is prevented by subcutaneous tunneling. Surgical technique is described and illustrated in a video. Implanted systems were immediately operational. Follow up period was 41 days. Each port was accessed 10 times and a total of 65'200 ml of fluid was drained. By the end of the forth week, pleural effusions diminished, systems were controlled for permeability and chest x-rays confirmed absence of effusion. Implanted port systems for refractory ascites and pleural effusions avoid morbidity and the patient's anxiety related to repeated puncture-aspiration. Large catheter diameter allows an easy and fast drainage of large volumes. Compared to chronic indwelling catheters, subcutaneous location of port system allows an entire integration, giving the patient a total liberty in daily life between two sessions of drainage. Drainage can be performed in an outpatient basis as an ambulatory procedure. This patient-friendly technique may be a treatment option in case of failure of other techniques.World Journal of Surgical Oncology 02/2008; 6:85. DOI:10.1186/1477-7819-6-85 · 1.20 Impact Factor
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ABSTRACT: The importance of quality-of-life (QOL) measurements in cancer management is being increasingly appreciated. This is especially important in patients with advanced cancers. Over 80% of women with epithelial ovarian cancer (EOC) will present with disease outside the ovary as there are no accurate screening tests, and symptoms usually do not develop until EOC has spread. Standard treatment includes debulking surgery followed by chemotherapy to which most women will have a complete response but only a minority of women with advanced disease will be cured. Fortunately, advances in surgical and chemotherapeutic management have improved overall survival with 45% of women of all stages living 5 years or longer. EOC may in many cases be considered a "chronic cancer," which highlights the importance of QOL in management decisions. QOL may be affected by the disease itself as well as by surgical and chemotherapeutic treatments. Future studies of the care and treatment of EOC patients should include well-designed QOL evaluations.Current Treatment Options in Oncology 12/2008; 8(6):402-16. DOI:10.1007/s11864-007-0049-6 · 3.24 Impact Factor