Table 2.
Malignant ascites drainage – complications’ rate and quality, and patients reported outcomes as provided in included literature.
| Author | No. of patients | Type of catheter | Technical success (%) | Symptoms control (%) | Complications rate, all
|
Complications rate (n), by type
|
Complications, comments | QOL
|
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|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AE, n (%) | SAE, n (%) | Infection G2 | Infection G3 | Leakage | Hypotension | Injury | Renal im pairment | Electrolyte imbalance | Obstruction | Catheter dislodgement | Other | QOL assessment tools (PR/AC/ST) | Results | ||||||
| Akinci et al (2011)3 | 40 | TPC | 100% | NA | 13(33%) | 8(20%) | 1 | 8 | 0 | 0 | 0 | 0 | 0 | 1 | 3 | 0 | NA | NA | |
| Barnett, Rubins (2002)43 | 29 | TPC | 100% | 93% | 5(17%) | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 2 | 1 | One poorly draining catheter – replaced for a new one | PR | Self-control, independency. |
| Belfort et al (1990)34 | 17 | TPC | 100% | 100% | 5(29%) | 1(9%) | 2 | 1 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | 0 | PR | All patients reported satisfaction and improvement in QOL. | |
| Bratby et al (2007)37 | 24 | PVS | 100% | NA | 11(46%) | 3(13%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 8 | 0 | 3 | One rapid death from pulmonary edema, 2 pneumothorax; 1 seroma at the venous insertion | NA | |
| Coupe et al (2013)4 | 24 | PPP | 100% | 100% | 5(21%) | 3(13%) | 0 | 1 | 0 | 1 | 0 | 1 | 2 | 1 | 0 | 0 | ST (ESAS) | Most important: pain and breathlessness relief | |
| Courtney et al (2008)5 | 34 | TPC | 100% | 83-100% | 19(56%) | 4(12%) | 0 | 1 | 7 | 0 | 1 | 0 | 0 | 2 | 0 | 8 | One with epigastric vein injured; five with dizziness and weakness, one with severe pain, one with sudden onset of shortness of breath and coughing, one anemia with transfusion required | ST (MSAS, SSQ) | 1st week – 56% reported improved overall QOL, 12th week – 28% reported improved QOL, |
| Easson et al (2007)10 | 61 | PC | NA | 78% | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | ST: ESAS:AM, EORTC: QLQ-C30, QLQ-PAN26 | Improvement in abdominal bloating, anorexia, dyspnea, insomnia, fatigue, mobility, role functioning, general QOL. Deterioration in cognitive and emotional subscales. |
|
| Fleming et al (2009)14 | 19 | FP | 100% | NA | 9 (47%) | 2(11%) | 0 | 1 | 2 | 0 | 0 | 0 | 0 | 5 | 0 | 0 | NA | NA | |
| TPC | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||||||||
| PPP | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||||||||
| Ghaffar et al (2014)30 | 40 | PPP | 100% | 97.5% | 2 (5%) | 1(2.5%) | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | NA | NA | |
| Gough and Balderson (1993)6 | 42 | PVS | NA | 64% | 11(26%) | 2(5%) | 0 | 0 | NA | 0 | 0 | 0 | 0 | 9 | 0 | 2 | Two deaths 6 and 12 hours after PVS insertion | AC | QOL not significant tendency (P=0.13) to improve. |
| Gu et al (2016)28 | 78 | CVC | 100% | 100% | 7(9%) | 0 | 0 | 0 | 7 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | PR | Alleviation in the mean scores for abdominal swelling, anorexia, constipation, fatigue. Comment: mean time of drainage 13 days. | |
| Harding et al (2012)18 | 18 | PC | 100% | NA | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Patients with ovarian cancer only, PC to dryness | NA | NA |
| Husain et al (2010)41 | 37 | PC | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | ST (ESAS:AM, EORTC QLQ-C30) | Improvement in scores on symptoms of abdominal distension, shortness of breath, role functioning. Global QOL did not improve. The domain of cognitive functioning declined, emotional - trend toward decline. | |
| Hussain et al (2004)36 | 13 | PVS | 100% | 92% | 5(38%) | 1(8%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 2 | 1 | One procedure-related mortality – pulmonary edema | NA | |
| Lee et al (2000)21 | 38 | TPC | 100% | 100% | 20(53%) | 15(39%) | 0 | 13 | 0 | 2 | 0 | 0 | 0 | 5 | 0 | 0 | Two with fatal hypotension; eight were lost to follow-up; | NA | NA |
| Lungren et al (2013)7 | 170 | TPC | 100% | NA | 14(8%) | 2(1%) | 3 | 2 | 4 | 0 | 0 | 0 | 0 | 0 | 5 | 0 | NA | NA | |
| Maleux et al (2016)8 | 97 | TPC | 100% | NA | 9(9%) | 0 | 2 | 0 | 4 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | NA | NA | |
| Mercadante et al (2008)26 | 40 | CVC | 100% | 75% | 10(25%) | 0 | 0 | 0 | 6 | 0 | 0 | 0 | 0 | 0 | 4 | 0 | Catheter “not working” in 17 cases – not precisely explained, including dislodgment. | AC | Symptoms rated by a patient on a linear scale from 0 to 3. |
| Monsky et al (2009)29 | 14 | PPP | 100% | 96% | 11(79%) | 0 | 0 | 0 | 4 | 0 | 3 | 0 | 0 | 2 | 0 | 2 | Three hematoma at port reservoir; four leakage to subcutaneous tissue / port site; two port site metastasis | ST/AC | On a 10-point scale, 9.5 by patients and 9.0 by the nursing staff QOL improvement. Details in text. |
| Narayanan et al (2014)54 | 38 | TPC | 100% | NA | 9(24%) | 2(5%) | 0 | 2 | 2 | 0 | 0 | 0 | 0 | 0 | 1 | 4 | Other: three patients reported pain, one sleep disturbances. | NA | |
| O’Neill et al (2001)55 | 24 | TPC | 100% | 100% | 4(17%) | 3(12%) | 0 | 3 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | NA | ||
| Orsi et al (2002)1 | 8 | PVS | 100% | 100% | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Patients’ selection: e.g. those renal failure, heart failure were excluded. | PR | Subjectively patients described a great improvement to their QOL. |
| Ozkan et al (2007)31 | 7 | PPP | 100% | NA | 4(57%) | 0 | 0 | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | Long-term patency 100%, but each time flushed with heparine. None of minor complications affected drainage. | NA | |
| Richard et al (2001)33 | 10 | TPC | 100% | NA | 2(20%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | NA | ||
| Rosenberg et al (2004)9 | 40 | TPC | 100% | NA | 3(8%) | 1(3%) | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | ascites loculations : PC – 2, TPC – 1. | NA | |
| 67 | PC | 100% | 5(8%) | 3(3%) | 0 | 3 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | |||||
| Ross et al (1989)42 | 43 | PC | 100% | 87% | 3(7%) | 2(5%) | 0 | 0 | 0 | 3 | 0 | 0 | 0 | 0 | 0 | 0 | Two fatal procedure-related hypotension | NA | |
| Savin et al (2005)32 | 28 | PPP | 100% | 96% | 1(4%) | 1(4%) | 0 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | One patient experiences leakage and subsequently peritonitis; 22/28 had MA | NA | |
| Seike et al (2007)11 | 20 | PVS | 100% | NA | 11(55%) | 3(15%) | 1 | 0 | 0 | 0 | 3 | 0 | 0 | 4 | 0 | 3 | PVS: one DIC; one fatal pulmonary embolism, one pulmonary edema; three subcutaneous bleeding; PC: all SAE were considered procedure-related | NA | |
| 49 | PC | 7(14%) | 7(14%) | 0 | 1 | 0 | 1 | 0 | 5 | 0 | 0 | 0 | 0 | ||||||
| Soderlund (1986)39 | 24 | PVS | NA | NA | 16(67%) | 6(25%) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 7 | 2 | 6 | One fatal pulmonary edema related to the procedure; five thromboembolisms | NA | |
| Stukan et al (2015)27 | 43 | CVC | 100% | 100% | 5(12%) | 0 | 1 | 0 | 0 | 1 | 0 | 1 | 1 | 3 | 0 | 0 | One patient with an occult primary and PS4 experienced hypotension, renal impairment and electrolyte imbalance | NA | |
| Tapping et al (2012)25 | 28 | TPC | 100% | NA | 11(39%) | 0 | 2 | 0 | 3 | 0 | 0 | 0 | 0 | 0 | 4 | 2 | One incisional site hernia | NA | |
| Tomiyama et al (2006)40 | 33 | PVS | 100% | NA | 18(55%) | 11(33%) | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 4 | 2 | 11 | Eight developed DIC - one died from DIC; three pulmonary edema - one died; one wound hematoma | PR | 60% of patients reported QOL improvement |
Notes: Technical success: successful catheter placement; injury: bowel, intra-abdominal, or abdominal wall vessels injury; G1–3: grading of AEs according to CTCAE (catheter-related infection); G2: localized; local intervention, indicated; oral intervention, indicated; G3: IV antibiotic, antifungal, or antiviral intervention indicated; radiologic or operative intervention indicated.
Abbreviations: AC, authors created questionnaire; AE, adverse event; CTCAE, Common Terminology Criteria for Adverse Events; CVC, central venous catheter (inserted intra-abdominally for ascites drainage); DIC, disseminated intravascular coagulation; EORTC, European Organization for the Research and Treatment of Cancer; ESAS, Edmonton Symptom Assessment Scale; ESAS:AM, ESAS – Ascites Modification; FP, French pigtail; IV, intravenous; MA, malignant ascites; MSAS, Memorial Symptom Assessment Survey; NA, not assessed/not applicable; PC, paracentesis; PPP, permanent peritoneal port; PR, patient reported; PVS, peritoneovenous shunts; QOL, quality of life; QLQ-C30, Quality of Life Questionnaire Core; QLQ-PAN26, Quality of Life Questionnaire Pancreatic cancer module; SAE, serious adverse event; SSQ, subjective significance questionnaire; ST, standardized questionnaire; TPC, tunneled peritoneal catheters (PleurX, Tenckhoff, other peritoneal)