Safety and Efficacy of the PleurX Catheter for the Treatment of Malignant Ascites

Abstract

Background: Malignant ascites is a common complication seen in association with various types of neoplastic processes. Due to high recurrence rates, patients may require multiple paracenteses, which have associated complications such as increased risk of bleeding, infection, pain, and volume and electrolyte depletion. Objective: This study evaluated the management of malignant ascites by placement of the PleurXÒ tunneled catheter system at a single center. Methods: This was a retrospective study of 38 patients who underwent PleurX catheter placement for refractory malignant ascites between February 2006 and March 2012 at our institution. Pretreatment characteristics and outcome measures were reported using descriptive statistics. Results: The population included 21 males and 17 females with a mean age of 60.6 years (range, 36-79 years) diagnosed with metastatic disease from a variety of primary malignancies, the most common of which was pancreatic cancer (10 patients). In 84% of patients (32/38) who were not lost to follow-up, mean survival time was 40.7 days (range 4-434 days). Technical success rate of catheter placement was 100%. Conclusions: The PleurX catheter can be used to manage malignant ascites in severely ill patients with metastatic cancer, with a high rate of procedural success and a low incidence of potentially serious adverse events, infections, or catheter-related complications.

Tunneled Indwelling Catheters for Malignant Ascites #308

“…4 Timing of placement for malignant ascites is empiric, though usually it is considered after a patient has had at least two prior LVPs. 2,4 Placement may also be considered in patients for whom disease burden makes frequent clinic visits difficult and when postprocedural symptoms, such as discomfort, fatigue, and dizziness, are troublesome. 3,4 The same considerations are relevant for nonmalignant ascites; however, due to survival and infection concerns, many clinicians limit the off-label use for nonmalignant ascites to patients with an anticipated survival of less than two months.…”

“…4,5 Insertion site erythema, bacterial peritonitis, and exudative drainage have been documented; associated superficial infections are often manageable with oral antibiotics. 2,4 Recent studies have shown much lower complication rates with the tunneled indwelling catheters, with 0.12 events per 100 catheter-days, compared with nontunneled catheter systems. Consequently, the use of nontunneled catheter systems for malignant ascites is essentially archaic.…”

“…1 This is usually performed as an outpatient procedure by an interventional radiology clinician. 2 Technical success rates for placement are near 100%. Catheters usually remain in place until death; a recent study found a mean length of retention of 113 days.…”

“…The one-way valve is opened with sterile technique, and up to two liters can be drained daily. 2 The drainage valve is closed when flow slows to a trickle, and fluid is disposed of in the toilet. During use, transient pain and cough may be experienced.…”

“…1,2 When ascites recurs after a large volume paracentesis (LVP), physical symptoms along with the need for travel to an office for repeat procedures can carry significant burden. 3 Tunneled indwelling peritoneal catheters are an alternative-a permanent drainage system that allows patients to control symptoms in the home setting.…”