Safety and Effectiveness of Palliative Tunneled Peritoneal Drainage Catheters in the Management of Refractory Malignant and Non-malignant Ascites.

Abstract

To determine the safety and effectiveness of tunneled peritoneal catheters in the management of refractory malignant and non-malignant ascites. An IRB-approved retrospective review was undertaken of patients who underwent ultrasound and fluoroscopy-guided tunneled peritoneal catheter placement for management of refractory malignant or non-malignant ascites between January 1, 2009, and March 14, 2014. A total of 137 patients (76M/61F, mean age 62.9years) underwent tunneled peritoneal catheter placement for refractory malignant (N=119; 86.9%) or non-malignant (N=18; 13.1%) ascites. Technical success was 100% with no immediate complications. Nineteen patients (13.9%) experienced a total of 11 minor and 12 major complications. Nine patients developed a catheter-associated infection. The remaining complications included leakage at the dermatotomy site (N=8), catheter dislodgement (N=2), obstruction (N=2), and groin pain (N=2). Patients who developed a catheter-associated infection had a significantly longer catheter dwell time compared to those who did not develop an infection (median, 96.5 vs. 20days; p<0.01). Nine patients (6.6%) were lost to follow-up. Of the remaining 128 patients, 125 died and the majority had a catheter in place (90.4%) at the time of death. There was one catheter-associated death (bacterial peritonitis; 0.8%). The median time from catheter placement to death was significantly shorter in patients with malignant versus non-malignant ascites (18.5 vs. 85days; p<0.0001). Tunneled peritoneal drainage catheters are effective and relatively safe in the management of malignant and non-malignant ascites. Longer catheter dwell time may be a risk factor for catheter-associated infection, particularly in patients with a longer anticipated survival in the palliative setting.