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

Symptomatic malignant ascites drainage with a patient-controlled vascular catheter: interim analysis of safety and patient-reported outcomes

Malignant ascites (MA) and repeated paracentesis can impair a patient's quality of life (QOL). The aim was to perform an interim analysis of safety and changes in patients' QOL in an ongoing prospective, multicentre (conducted within the Central and Eastern European Gynaecologic Oncology Group (CEEGOG)) trial on symptomatic MA drainage with a patient-controlled central vascular catheter (CVC) inserted into the abdominal cavity. CVC (14-Ga) was inserted into the abdominal cavity of patients with symptomatic MA, and drainage was controlled by patients at home. The rate and quality of complications were classified according to Common Terminology Criteria for Adverse Events Version 5.0. QOL was evaluated before and 10-14 days after/during drainage with standardized QLQ-C15-PAL, SGA, and FACIT-TS-G questionnaires. Wilcoxon and Chi-squared tests were used. Among 113 recruited patients (2015-2022), seven patients experienced complications (6.2%), and there was one patient with a serious adverse event (death on the 9th day after catheter insertion, classified as not related to the intervention). Adverse events included local infection (n = 2) (resolved after oral antibiotics), catheter obstruction (n = 2), catheter self-removal (n = 2) (re-insertion performed), and nausea (n = 1). When comparing the assessment before and after/during drainage, we found the significantly better global QOL (mean 31.8 vs. 47.8, p < 0.001), improvement in physical (52.6 vs. 64.4, p < 0.001) and emotional functioning (50.7 vs. 65.4, p < 0.001); symptoms were significantly less intense: fatigue (66.7 vs. 50.9, p < 0.001), nausea and vomiting (37.8 vs. 21.4, p < 0.001), pain (53.9 vs. 34.1, p < 0.001), dyspnoea (48.5 vs. 22.3, p < 0.001), insomnia (49.1 vs. 34.3, p < 0.001), appetite loss (56.3 vs. 40.3, p < 0.001), and constipation (31.0 vs. 25.2, p = 0.007), and more patients had no pain on eating (71.3% vs. 82.9%, p = 0.04). Most patients (78%) were satisfied, 83% would recommend the procedure to others, and 90% would choose intervention again. The interim analysis provided data on the safety and improvement of patients' QOL after MA drainage via patient-controlled CVC inserted into the abdominal cavity, thus justifying the continuation of recruitment for the main trial without changes in the protocol.

Safety and Prognostic Factor for Survival in Patients with PleurX Drain for Malignant Ascites: AscitX Study

Background: Malignant ascites (MA) represents 10% of all causes of ascites and is associated with a poor prognosis. The PleurX tunneled peritoneal catheter is a device that allows the management of MA at home in a palliative care context (renamed AscitX catheter for this work). The objective of this study was to analyze real-world data of AscitX use for cancer patients with MA, to describe complications associated with the insertion of this device, and to identify factors influencing patient outcomes. Methods: Fifty-six patients with AscitX catheter insertion between October 2018 and October 2022 in our comprehensive cancer center were retrospectively analyzed. Computed tomography (CT) scans were reviewed by two radiologists to determine the presence of liver and peritoneal metastases and to identify portal hypertension. Results: The majority of patients were followed for pancreatic cancer (39%), followed by ovarian cancer (18%). We identified four cases of severe infections post-insertion and two moderate infections. The median survival time after AscitX insertion was 18 days. A Kaplan-Meier analysis did not identify differences in survival time between patients with peritoneal metastases and those with liver metastases. In contrast, CT-diagnosed portal hypertension and the absence of diuretic treatment were independently associated with a better prognosis. Regarding post-catheter end-of-life management, 41% of the patients died at home. Conclusions: AscitX catheter safety appears to be acceptable and most of the palliative care patients included in our study died at home. We identified CT-diagnosed portal hypertension as associated with better prognosis, as well as the absence of diuretic treatment.