123 Improving quality of life in malignant ascites with indwelling peritoneal drains

Abstract

Introduction Traditional management of malignancy related ascites (MRA) is via large volume paracentesis (LVP). NICE recommends indwelling peritoneal catheters, (IPCs) which are cost effective and patient centred. A service and practice guidelines were set up. Ongoing reviews assess safety and efficacy and inform future pathways. Methods A single centre retrospective analysis of patients requiring IPCs between October 2018 and August 2020 was performed. Demographics and outcomes were collected. Descriptive statistical methodology was applied. IPCs are placed in theatre or dedicated clean spaces, with pre-operative antibiotics. Results 27 patients (14 male, 13 female) underwent 28 IPC placements. [1 patient had 2 IPCs (this will not be discussed as case is published)]. Diagnoses were gastrointestinal (13), breast (2), ovarian (5), prostate (1), thymic (1), unknown primary (4) cancers and 1 mesothelioma. 3 had no preceding LVP; 24 had a mean of 2.2 LVPs before. 6 developed post-operative leaks. 2 patients developed cellulitis. Bacterial colonisation occurred in 1 patient. 4 IPCs were removed: 2 as ascites resolved, 1 for tumour infiltration, 1 for non-resolving site cellulitis. 24 patients have died: mean number of days to death: 56.4 (range 6–262). Integrated Palliative Care Outcome Scale scores collected in 20 patients consistently show sustained reduction in pain, dyspnoea, nausea, vomiting, drowsiness, distension and improvements in body image and appetite. Conclusions IPCs are safe and efficient. More formal evidence is required on some aspects. A grant application has been submitted to the Royal College of Physicians for the Dorothy Whitney-Wood scholarship to perform a systematic review of the literature, a survey through the APM and an open labelled prospective study to determine if patients with MRA should have an IPC at first presentation and correlate with quality of life outcomes. We also propose sequential analysis of peritoneal fluid to assess bacterial colonisation and effect on outcomes.