Long-term semi-permanent catheter use for the palliation of malignant ascites
Washington University, Department of Obstetrics and Gynecology, 660 S. Euclid, St. Louis, MO 63110, USA. Gynecologic Oncology
(Impact Factor: 3.77).
06/2006; 101(2):360-2. DOI: 10.1016/j.ygyno.2005.12.043
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.
Available from: PubMed Central
- "Concerns about catheter drainage have included infection, protein loss, and technical complications such as catheter dislodgment and blockage. Types of catheters include the simple catheter, tunneled catheters, percutaneously placed peritoneal ports, modified venous access ports, and the PleurX catheter.46 The PleurX catheter was FDA approved for the management of malignant ascites in 2005.47 "
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ABSTRACT: Malignant ascites is the abnormal accumulation of fluid in the peritoneal cavity associated with several intrapelvic and intra-abdominal malignancies. The development of ascites leads to significant symptoms and poor quality of life for the cancer patient. Available therapies for palliation include treatment of the underlying disease, but when there are no treatment options, the use of diuretics, implantation of drainage catheters, and surgical shunting techniques are considered. None of these symptom palliation options affect the course of disease. The development of trifunctional antibodies, which attach to specific overexpressed surface markers on tumor cells, and trigger an immune response leading to cytoreductive effects, represents a new approach to the management of malignant ascites. The purpose of this review is to highlight current therapies for malignant ascites and review data as to the effectiveness of a new trifunctional antibody, catumaxomab.
Available from: Patrick Myers
- "Malignant ascites leads to shortness of breath, nausea, diminished appetite and early satiety, fatigue, lower extremity edema, limited mobility and difficulty to fit clothes. Ascites results from multiple mechanisms including vascular permeability changes, peritoneal carcinomatosis (metastatic implants of carcinoma on the peritoneal cavity), lymph drainage obstruction, hepatic congestion due to tumour infiltration or neoplastic production of exudative fluid . Ascites may develop in various circumstances but mainly in cirrhosis and peritoneal carcinomatosis. "
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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.
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