Prospektive Evaluation der Effektivität und Sicherheit getunnelter Aszitesdrainagen bei palliativen Patient*innen mit therapierefraktärem Aszites bei maligner Grunderkrankung
by Felix Constantin Heuschert
Date of Examination:2022-10-13
Date of issue:2022-09-28
Advisor:PD Dr. Albrecht Neeße
Referee:PD Dr. Albrecht Neeße
Referee:Dr. Joachim Erlenwein
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EnglishTreatment of recurrent malignant ascites in cancer patients is a challenge. Evidence based guide-lines regarding the best treatment strategy are lacking. The aim of this prospective study was to investigate the safety and efficacy of tunneled peritoneal catheter (PleurX) in cancer patients with symptomatic ascites. Patients with symptomatic, diuretics-refractory ascites and indication for the implantation of a tunneled peritoneal PleurX catheter were prospectively enrolled between August 2018 and July 2020. Number of catheter days, complications, amount of drained ascites and ascites-associated symptoms and hospitalization rate pre and post PleurX insertion were an-alyzed. Here, 51 Patients (64.7% male) were prospectively enrolled. Mean age was 66.6 (±7.9) years. Most common cause of ascites was pancreatic adenocarcinoma (n=10) followed by cholan-giocellular carcinoma (n=9) and hepatocellular carcinoma (n=8). The technical success rate of PleurX implantation was 100%. Mean volume of weakly drained ascites was 5.44l (±4.08). Major complications were cellulitis (n=2), peritonitis and drainage dislocation (each n=1). Mean cathe-ter days per patient were 59.8 (± 107.4) (Min 4, Max 668). Abdominal discomfort, impaired mo-bility, dyspnea, fatigue, nausea and vomiting were significantly reduced 30 days after PleurX in-sertion (p<0.05). Moreover, hospitalization rate was significantly reduced (p<0.001; 27.08% of days pre- implantation vs. 11.27% post-implantation). We conclude that implantation of a tun-neled ascites catheter is a safe and effective method for the treatment of refractory ascites in can-cer patients with advanced disease. Serious complications are rare. Burdensome ascites-associated symptoms and hospitalization rate can be significantly reduced over a longer period of time.
Keywords: symptomatic ascites; malignant ascites; PleurX catheter; tunneled peritoneal catheter; diuretic resistant ascites; permanent ascites drainage