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Pleurx Tunneled Catheter in the Management of Malignant Ascites

https://doi.org/10.1016/S1051-0443(07)61919-8Get rights and content

The authors report their experience with the Pleurx tunneled catheter in patients with end-stage abdominal carcinomatosis and intractable ascites. Ten patients with intractable ascites and abdominal carcinomatosis underwent placement of tunneled Pleurx catheters. The catheters were placed with combined US and fluoroscopic guidance. Patients' charts were reviewed for procedural complications, serum albumin levels, infection, efficacy of catheters in providing effective drainage of ascites, and duration of catheter patency. There were no procedural complications. The serum albumin level decreased from 2.7 g/L to 2.3 at 3 weeks and 2.4 g/L at 6 weeks. There were no catheter infections. Some patients required continuous drainage, whereas others were successfully treated by drainage once per week. Mean catheter survival was 70 days. In patients with end-stage abdominal carcinomatosis complicated by malignant ascites, the Pleurx tunneled catheter can provide effective palliation and alleviated the need for repeated percutaneous paracentesis.

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MATERIALS AND METHODS

Ten patients who where managed with optimum medical care and repeated large volume paracentesis for malignancy related ascites were referred for placement of a tunneled Pleurx catheter. There were seven male patients and three female patients whose ages ranged from 43 to 78 years (mean, 61 y). The patients' underlying malignancies were gastrointestinal in seven and breast, lymphoma, and mesothelioma in one each.

The Pleurx catheter is a 15.5-F catheter with 30 side holes along its distal 26 cm.

RESULTS

Eight of the catheters were placed with combined US and fluoroscopic guidance. Two of the catheters were placed with US guidance alone because fluoroscopic guidance was deemed unnecessary in patients with large amounts of free-flowing ascites. No periprocedural complications were identified, specifically, no patients exhibited hypotension. The patients' initial drainage was 1.5–3 L of ascites. The patients initially drained between 0.5Land1Lof fluid per day for the first week and the amount of

DISCUSSION

Malignant ascites is a dreaded complication of metastatic cancers, such as ovarian, colon, gastric, pancreatic, and breast cancers, mesothelioma, and lymphoma. In most series, the mean survival ranges from 2 to 4 months (1, 2). Malignant ascites can be secondary to peritoneal carcinomatosis, lymphangitic carcinomatosis, or massive hepatic metastasis. Patients with peritoneal carcinomatosis have extensive metastatic implants on the peritoneal surfaces. These implants give rise to elevated

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    Smith et al33 found that paracentesis provided palliation in 93% of patients but had a limited duration of effect, with a mean of 10.4 days and with potential risk. Therefore, to minimize repeated paracenteses and frequent hospital visits, permanent drains are frequently used.21,23,34 We observed in our cohort that 36% (n = 64) of patients underwent paracenteses only as the means of managing ascites, with 58% of this subgroup (n = 37) having 1 to 2 paracenteses, and only 14% (n = 9) having ≥ 3 paracenteses.

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    Additional procalcitonin evaluation can be implemented as a routine use in clinical practice [18]. In patients with end-stage abdominal carcinomatosis complicated by MA, the Pleurx tunneled catheter provided effective palliation and alleviated the need for repeated percutaneous paracentesis (experience with ten patients) [19]. The safety and effectiveness were confirmed on 28 consecutive patients (32 drain insertions) with refractory MAs.

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From the SCVIR 2000 Annual Meeting.

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