3:54 PM Abstract No. 113 - Evaluation of tenckhoff catheter placement for symptomatic refractory malignant ascites

Abstract

Purpose To assess patient outcome following Tenckhoff catheter insertion for the palliation of malignant ascites in patients with advanced peritoneal carcinomatosis. Materials and Methods A retrospective review was undertaken of all Tenckhoff catheter placements performed in our department between Jan 2011 and Sept 2012. The electronic medical record was examined to collect data on patient demographics, number of catheter days, type of tumor, peri-procedural complications, clinical follow-up, and need for additional interventions. Results 62 patients (average age 59.8; 40 female, 22 male) underwent catheter placement for treatment of refractory malignant ascites. Tumor types included ovarian (19), pancreaticobiliary (13), colorectal (7) and gastric (7) melanoma (4), and others. Technical success of catheter insertion was achieved in all cases. Initial drainge volume at the time of catheter insertion was 2.4 L and was dependent, in part, on how recently a paracentesis had been performed. The total number of catheter-days was 2720 (range, per patient 2-142). During the follow-up period, four major complications were identified: 3 patients (4.8%) developed bacterial peritonitis, and one had hemoperitoneum, all requiring hospital admission; three others (4.8%) had pericatheter cellulits. Two catheters were clogged which were treated by instillation of r-tPA in one and clot aspiration in the other. Another patient had pericatheter leakage of ascites due to catheter migration requiring exchange and revision. Two patients required an additional catheter placement on the contralateral side. Twenty patients (32%) died within two weeks of the procedure and thirty (48%) within four weeks from progression of their metastatic disease. Fifty-six (90%) of patients realized a definite clinical benefit and improved quality of life as documented by markedly reduced abdominal girth and/or less discomfort at the time of last follow-up. Conclusion Tenckhoff catheter placement is a safe and efficacious procedure for the treatment of malignant ascites in terminally ill patients with relatively low associated morbidity.