Therapeutic Procedures for Malignant Ascites in a Palliative Care Outpatient Clinic
| Autor: | Juho T. Lehto, Niina Paunu, Veera V. Salminen, Tiina Luukkaala, Reetta P. Piili, Säde Korpi |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Palliative care 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Catheters Indwelling Ascites Paracentesis medicine Ambulatory Care Outpatient clinic Humans Intensive care medicine General Nursing Finland Aged Aged 80 and over medicine.diagnostic_test business.industry Optimal treatment Palliative Care General Medicine Middle Aged Pancreatic Neoplasms Anesthesiology and Pain Medicine 030220 oncology & carcinogenesis Hospice and Palliative Care Nursing Female medicine.symptom business |
| Zdroj: | Journal of palliative medicine. 21(6) |
| ISSN: | 1557-7740 |
| Popis: | The optimal treatment of malignant ascites (MA) and feasibility of the management with free drainage remain unclear.To study the success of drainage, complications, and survival after paracentesis or insertion of an indwelling tunneled catheter (TC) for the MA performed on a day-case basis.We evaluated 118 paracenteses and 48 insertions of TCs performed in 104 patients with MA at the Palliative Care Outpatient Unit of Tampere University Hospital.Drainage of ascites fluid (median 3700 mL; range 300-13,200 mL) was successful in all cases. The complication rates were 7% and 25% for paracenteses and TCs, respectively. Most of the complications were minor. Repeated procedures were needed in 64% and 10% of the paracenteses and insertions of TCs, respectively, (p 0.001). Median survival after the first procedure was 40 days (interquartile range, IQR: 17-115). Patients with pancreatic cancer had shorter median survival (19 days; IQR: 9-35) compared with other patients (47 days; IQR: 23-143) (age-adjusted HR 2.73; 95% CI: 1.65-4.52), whereas patients receiving chemotherapy had longer median survival (112 days; IQR: 43-205) compared with patients without chemotherapy (25 days; IQR: 14-52) (age-adjusted HR 2.48; 95% CI: 1.58-3.89). The volume of removed ascites fluid was not associated with survival.Free drainage of MA seems feasible in an outpatient clinic. Early insertion of TC should be considered to avoid repeated paracenteses. However, in patients with pancreatic cancer, paracentesis might be an accepted alternative due to their short life expectancy. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|