Tunnelled Peritoneal Catheter for Malignant Ascites—An Open-Label, Prospective, Observational Trial

SIMPLE SUMMARY: Recurrent abdominal fluid collection (ascites) is a common clinical problem in patients with advanced malignancy that causes abdominal discomfort, nausea, fatigue and dyspnoea. Repetitive large volume paracentesis is the standard procedure that relieves patients from abdominal fluid; however, the procedure is painful and needs to be repeated up to several times per week. Tunnelled peritoneal PleurX catheters are implanted in the abdominal cavity as a permanent solution to drain ascites and can be used by the patient or nursing staff at home. In this study, we prospectively investigate the feasibility and safety of tunnelled peritoneal PleurX catheters in patients with malignant ascites. Our findings show that this technique is safe and can be routinely used. Tunnelled peritoneal PleurX catheters effectively reduce ascites-associated symptoms and hospitalization rates. Therefore, this technique should be considered in patients with recurrent malignant ascites. ABSTRACT: Treatment of recurrent malignant ascites in cancer patients is a challenge. Evidence based guidelines regarding the best treatment strategy are lacking. The aim of this prospective study was to investigate the safety and efficacy of a tunnelled peritoneal catheter (PleurX) in cancer patients with symptomatic ascites. Patients with symptomatic, diuretics-refractory ascites and indication for the implantation of a tunnelled peritoneal PleurX catheter were prospectively enrolled between August 2018 and July 2020. The number of catheter days, complications, amount of drained ascites and ascites-associated symptoms and hospitalization rate pre- and post-PleurX insertion were analysed. 51 Patients (64.7% male) were prospectively enrolled. The mean age was 66.6 (±7.9) years. The most common cause of ascites was pancreatic adenocarcinoma (n = 10) followed by cholangiocellular carcinoma (n = 9) and hepatocellular carcinoma (n = 8). The technical success rate of PleurX implantation was 100%. The mean volume of weakly drained ascites was 5.44l (±4.08). Major complications included cellulitis (n = 2), peritonitis and drainage dislocation (each n = 1). The mean catheter days per patient was 59.8 (±107.4) (Min 4, Max 668). Abdominal discomfort, impaired mobility, dyspnoea, fatigue, nausea and vomiting were significantly reduced 30 days after PleurX insertion (p < 0.05). Moreover, hospitalization rate was significantly reduced (p < 0.001; 27.08% of days preimplantation vs. 11.27% postimplantation). We conclude that implantation of a tunnelled ascites catheter is a safe and effective method for the treatment of refractory ascites in cancer patients with advanced disease. Serious complications are rare. Burdensome ascites-associated symptoms and hospitalization rates can be significantly reduced over a longer period of time.