Therapeutic Procedures for Malignant Ascites in a Palliative Care Outpatient Clinic.

ABSTRACT

BACKGROUND: The optimal treatment of malignant ascites (MA) and feasibility of the management with free drainage remain unclear. OBJECTIVE: To study the success of drainage, complications, and survival after paracentesis or insertion of an indwelling tunneled catheter (TC) for the MA performed on a day-case basis. DESIGN AND SETTING: We evaluated 118 paracenteses and 48 insertions of TCs performed in 104 patients with MA at the Palliative Care Outpatient Unit of Tampere University Hospital. RESULTS: Drainage of ascites fluid (median 3700 mL; range 300-13,200 mL) was successful in all cases. The complication rates were 7% and 25% for paracenteses and TCs, respectively. Most of the complications were minor. Repeated procedures were needed in 64% and 10% of the paracenteses and insertions of TCs, respectively, (p < 0.001). Median survival after the first procedure was 40 days (interquartile range, IQR 17-115). Patients with pancreatic cancer had shorter median survival (19 days; IQR 9-35) compared with other patients (47 days; IQR 23-143) (age-adjusted HR 2.73; 95% CI 1.65-4.52), whereas patients receiving chemotherapy had longer median survival (112 days; IQR 43-205) compared with patients without chemotherapy (25 days; IQR 14-52) (age-adjusted HR 2.48; 95% CI 1.58-3.89). The volume of removed ascites fluid was not associated with survival. CONCLUSIONS: Free drainage of MA seems feasible in an outpatient clinic. Early insertion of TC should be considered to avoid repeated paracenteses. However, in patients with pancreatic cancer, paracentesis might be an accepted alternative due to their short life expectancy.