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Management of symptomatic ascites and post-operative lymphocysts with an easy-to-use, patient-controlled, vascular catheter.
Gynecol Oncol. 2014 Nov 27;
Authors: Stukan M, Lesniewski-Kmak K, Wroblewska M, Dudziak M
Abstract
OBJECTIVE: Malignant ascites (MA) can be managed with paracentesis, diuretics, shunt-systems, chemotherapy, and targeted therapies. Some treatments are ineffective; others are associated with complications, involve inpatient procedures, or are not cost-effective. Postoperative lymphocysts (LC) are managed with inpatient drainage and sclerotherapy or surgery. We tested the use of a vascular catheter in the management of symptomatic MA and LC.
METHODS: Fifty-five patients with primary or recurrent cancers with ascites or LC were managed for symptom relief. A central venous 14-Ga 16-cm catheter (Arrow ®) was inserted into the abdominal cavity or LC, followed by drainage.
RESULTS: The catheter was safely inserted with ultrasound guidance in 43 patients with MA (39 with ovarian cancer: 9 before primary cytoreduction, 30 with recurrence; 4 non-gynecological cancers), and 12 patients with LC (10 retroperitoneal, 2 bilateral inguinal). All procedures were performed in the outpatient department under local anesthesia, without insertion-related complications. Within a mean of 30days after catheter placement (range: 7-90 days), no grade 3 infection, peri-drain leakage, or self-removal were noted. In three patients with recurrent ovarian mucinous ascites and one patient with an inguinal LC, some drain obstruction was noted. In cases before primary cytoreduction for ovarian cancer, drainage enabled better nutritional and anesthiological outcomes. Patients with chronic ascites were able to self-monitor the amount of evacuated fluid. Twelve patients whose ascites were drained had chemotherapy at the time, and they reported better wellbeing, and we estimated better performance status. LC drainage followed by sclerotherapy enabled symptom control and LC radical treatment.
CONCLUSION: Use of the vascular catheter is safe, easy, and cost-effective in the management of symptomatic MA and LC.
PMID: 25434633 [PubMed - as supplied by publisher]