Tenckhoff tunneled peritoneal catheter placement in the palliative treatment of malignant ascites: technical results and overall clinical outcome

Abstract

BackgroundTo assess the technical and clinical outcome of percutaneous insertion of tunneled peritoneal catheters in the palliative treatment of refractory malignant ascites and to determine the safety and feasibility of intraperitoneal administration of cytotoxic drugs through the tunneled catheter.Materials and methodsConsecutive patients palliatively treated with a tunneled peritoneal catheter to drain the malignant ascites were identified. Patients’ medical history, procedural and clinical follow-up data, including complications and estimated survival, were reviewed. Additionally, a sub analysis of the patients with widespread ovarian cancer and refractory ascites treated with or without intraperitoneal administration of cytotoxic drugs was made.ResultsIn all 94 patients it was technically feasible to insert the peritoneal drainage catheter and to drain a median of 3260 cc (range 100 cc – 8500 cc) of malignant ascitic fluid. Post procedural complications included catheter infection (n = 2; 2%), fluid leakage around the entry site (n = 4; 4%), catheter occlusion (n = 2; 2%), sleeve formation around the catheter tip (n = 1; 1%) and accidental loss of the catheter (n = 1; 1%). There was no increase in catheter infection rate in patients treated with or without intraperitoneal administration of cytotoxic drugs. Median overall survival after catheter insertion is 1.7 months.ConclusionsPercutaneous insertion of a tunneled Tenckhoff catheter for the palliative drainage of malignant ascites and intraperitoneal infusion of cytotoxic drugs is feasible and associated with a very low complication rate, including catheter infection. These tunneled peritoneal lines are beneficial for symptomatic palliative treatment of refractory ascites and allow safe intraperitoneal chemotherapy.

Drainage of malignant ascites: patient selection and perspectives

“…The underlying malignancy, its symptoms, and prognosis are important to direct clinical decision making in MA drainage. The life expectancy of patients with refractory MA is very poor, with an overall survival ranging from 1 to 6 months in nonovarian cancer and 10–24 months in ovarian cancer 8,12,44. Patients with refractory MA with a longer life expectancy, such as patients with gynecologic tumors, may also benefit from the use of a tunneled catheter for a longer period, compared with patients with more aggressive tumors such as gastrointestinal malignancies 8…”

“…Therefore, chemotherapy should not be a contraindication to catheter placement 27,47. An additional advantage of TPC or PPP for ascites drainage is that intraperitoneal infusion of chemotherapy (cisplatin) or active targeted therapeutic agents (catumaxomab) is possible 8,31…”

Permanent peritoneal ports for the management of recurrent malignant ascites: a retrospective review of safety and efficacy

“…Tunnelled indwelling catheters are catheters which are inserted into the abdomen, with residual tubing left outside of the abdomen to enable access . The National Institute for Health and Clinical Excellence in the United Kingdom recommends that this type of drainage system be considered in patients with treatment‐resistant recurrent malignant ascites .…”

“…5,16,17 Tunnelled indwelling catheters are catheters which are inserted into the abdomen, with residual tubing left outside of the abdomen to enable access. [18][19][20] The National Institute for Health and Clinical Excellence in the United Kingdom recommends that this type of drainage system be considered in patients with treatmentresistant recurrent malignant ascites. 21 Several studies have demonstrated the cost-effectiveness of tunnelled indwelling catheters over large volume paracentesis, particularly if the patient requires frequent paracentesis.…”

Oncolytic Adenovirus-Loaded Menstrual Blood Stem Cells Overcome the Blockade of Viral Activity Exerted by Ovarian Cancer Ascites

“…Current treatments for advanced stages of ovarian cancer include either primary cytoreductive surgery followed by adjuvant chemotherapy or neoadjuvant chemotherapy followed by interval cytoreductive surgery and adjuvant chemotherapy 4, 5. The use of neoadjuvant treatments remains controversial, 1 although the American Society of Clinical Oncology recently recommended their use 3 . The use of antiangiogenic agents such as bevacizumab, a humanized anti-vascular endothelial growth factor (VEGF) monoclonal antibody, is another possibility for treating ovarian cancer 6 .…”