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Drainage of malignant ascites: patient selection and perspectives
#MMPMID28442933
Stukan M
Cancer Manag Res
2017[]; 9
(?): 115-130
PMID28442933
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Malignant ascites (MA) is a sign of advanced cancer and poor prognosis. MA can
result in impairment in quality of life (QOL) and significant symptoms. As a
supportive treatment, ascites can be drained by paracentesis (PC), percutaneously
implanted catheters (tunneled, untunneled, central venous catheters), or
peritoneal ports, or peritoneovenous shunts. The aim of this study was to
evaluate the effectiveness, safety, and patient-reported outcomes (PRO) of
different drainage methods for the management of MA. A systematic review of the
literature was performed, and 32 original articles met the inclusion criteria.
Patients selected for permanent drain insertion demonstrated symptoms related to
MA and had undergone repeated PC. The primary focus of the reviewed articles was
procedural safety issues. The rate of technical success of drainage device
installation was 100%. Most patients experienced improvements in symptom control
after ascites drainage. When analyzed together, 19.7% (255/1297) of patients
experienced any complication and 6.2% (81/1297) experienced serious adverse
events during MA drainage. Complications were reported for every drainage method;
however, the least occurred after PC or central venous catheter, while the most
serious occurred after peritoneovenous shunts. Adverse events were as follows:
catheter obstruction: 4.4%, infection: 4.1%, leakage: 3.5%, catheter dislodgment:
2.3%, hypotension: 0.6%, injuries during device insertion: 0.6%, renal
impairment: 0.5%, electrolyte imbalance: 0.2%, other: 3.6%. PRO and QOL endpoints
were available for 12 studies. When PRO were measured using an interview, a
significant improvement in symptom control and QOL was reported in almost all
patients. Once standardized questionnaires were used, improvements in symptomatic
scores and role functioning were observed. Deterioration was observed in
cognitive and emotional subscales. MA drainage is a safe and effective method to
control symptoms associated with ascites, and should be perceived as a supportive
care, that can be applied for those who need it at any time of their cancer
trajectory. Patient selection should be performed using a thorough assessment of
symptoms and QOL, and should not be delayed.
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