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Annals of Surgical Oncology Feb 2013Fluoroscopic-guided placement of a percutaneous decompression gastrostomy tube (PDGT) is used to palliate patients with malignant bowel obstruction (MBO). We report our...
BACKGROUND
Fluoroscopic-guided placement of a percutaneous decompression gastrostomy tube (PDGT) is used to palliate patients with malignant bowel obstruction (MBO). We report our clinical experience in cases of MBO and ascites that were known to be technically difficult and at increased risk for complications after PDGT placement.
METHODS
Between October 2005 and April 2010, a total of 89 consecutive oncology patients with MBO and ascites underwent at least one attempt at PDGT placement. We retrospectively reviewed the electronic medical record to collect demographic details, procedure information, and morbidity and mortality data. Kaplan-Meier curves were used to calculate median survival after PDGT.
RESULTS
Ninety-three new gastrostomy encounters occurred in 89 patients. The primary and secondary technical success rates were 72 % (67 of 93) and 77.4 % (72 of 93), respectively. Inadequate gastric distention was the reason for failure in 84.6 % (22 of 26) of the cases in which the initial PDGT attempt was unsuccessful. For ascites management, 13 patients underwent paracentesis and 78 patients underwent placement of an intraperitoneal catheter. The overall complication rate in successful placements was 13.9 %, with a major complication rate of 9.7 %. After PDGT, the median overall survival rate was 28.5 days (95 % confidence interval 20-42).
CONCLUSIONS
PDGT is feasible in the majority of patients with MBO and ascites, although there is an inherent risk of major complications. An intraperitoneal catheter can be used to manage ascites to facilitate PDGT.
Topics: Adult; Aged; Aged, 80 and over; Ascites; Feasibility Studies; Female; Follow-Up Studies; Gastrostomy; Humans; Intestinal Obstruction; Male; Middle Aged; Neoplasm Staging; Neoplasms; Palliative Care; Prognosis; Survival Rate; Young Adult
PubMed: 22965572
DOI: 10.1245/s10434-012-2643-5 -
Annals of Oncology : Official Journal... May 2007Malignant ascites is a manifestation of end stage events in a variety of cancers and associated with a poor prognosis. We evaluated the pattern of cancers causing... (Comparative Study)
Comparative Study
BACKGROUND
Malignant ascites is a manifestation of end stage events in a variety of cancers and associated with a poor prognosis. We evaluated the pattern of cancers causing malignant ascites and factors affecting survival.
PATIENTS AND METHODS
Patients coded with the International Classification of Diseases-9 coding system for malignant ascites over a 2-year period were reviewed. The clinicopathological data and patients' survival were compared among cancer groups.
RESULTS
There were 209 patients (140 females and 69 males), median age being 67 (30-98) years. The commonest cancer was ovarian followed by gastrointestinal (GI) cancers. Fifty-eight per cent of the patients had symptoms related to the ascites. Liver metastases were significantly commoner in the GI cancers (P = 0.0001). Fifty-four per cent of our patients presented with ascites at the initial diagnosis of their cancer. Paracentesis was given to 112, diuretics to 70 and chemotherapy to 103 patients. The median survival following diagnosis of ascites was 5.7 months. Ovarian cancer favoured longer survival while low serum albumin, low serum protein and liver metastases adversely affected survival. The independent prognostic factors for survival were cancer type, liver metastases and serum albumin.
CONCLUSION
The identified independent prognostic factors should be used to select patients for multimodality therapy for adequate palliation.
Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Ascites; Blood Proteins; Diuretics; Female; Follow-Up Studies; Gastrointestinal Neoplasms; Humans; Liver Neoplasms; Male; Middle Aged; Ovarian Neoplasms; Paracentesis; Prognosis; Retrospective Studies; Serum Albumin; Survival Analysis; Time Factors; Treatment Outcome
PubMed: 17298959
DOI: 10.1093/annonc/mdl499 -
Japanese Journal of Clinical Oncology Mar 2021This phase 2 study examined the efficacy and safety of tolvaptan, an aquaretic drug, in the treatment of ascites associated with cancer.
OBJECTIVE
This phase 2 study examined the efficacy and safety of tolvaptan, an aquaretic drug, in the treatment of ascites associated with cancer.
METHODS
In the dose-escalation phase, oral tolvaptan was initiated at a dose of 3.75 mg/day, and the dose was increased daily to 7.5, 15 and 30 mg/day. Dose escalation was terminated once the increase from baseline in the daily urine volume reached 500 ml, at which point the patient proceeded to the maintenance phase of 5-7 days. Improvement of ascites was determined primarily by reduction in body weight and ascitic fluid volume.
RESULTS
The mean change from baseline in body weight was maintained below 0 kg throughout the study. The mean change (±standard deviation) from baseline in ascitic fluid volume at the end of treatment (EOT) was 237.45 ± 868.14 ml in 33 evaluable patients. Although an increase from baseline in ascitic fluid volume at the EOT was observed in 23 of 33 patients (maximum: 1589.3 ml, minimum: 3.83 ml), a reduction in ascitic fluid volume was observed in the remaining 10 patients (maximum: -2304.3 ml, minimum: -27.5 ml). The common treatment-emergent adverse events included vomiting (5 of 43 patients, 11.6%), abdominal distension, constipation, thirst, blood osmolarity increased and renal impairment (3 of 43 patients, 7.0% each).
CONCLUSIONS
Tolvaptan seemed to have no definitive effect on reducing ascites; however, it might be effective in at least some cancer patients. No new safety concerns were identified at doses of 3.75-30 mg/day.
Topics: Aged; Antidiuretic Hormone Receptor Antagonists; Ascites; Body Weight; Female; Humans; Male; Tolvaptan; Treatment Outcome
PubMed: 33173939
DOI: 10.1093/jjco/hyaa196 -
Annals of Palliative Medicine Nov 2020Indwelling abdominal drains for intermittent drainage is an effective treatment for refractory malignant ascites, bacterial colonization and subsequent drain-related...
BACKGROUND
Indwelling abdominal drains for intermittent drainage is an effective treatment for refractory malignant ascites, bacterial colonization and subsequent drain-related infection is however a common concern. This study aimed to investigate the patterns of bacterial colonization and the subsequent infection outcomes in patients with indwelling abdominal drains.
METHODS
All consecutive advanced cancer patients with newly inserted indwelling abdominal drains and who were under the service of the ascites clinic of our institution for intermittent drainage between January 2011 and March 2018 were screened for study eligibility. Patients with positive surveillance ascitic fluid culture without immediate drain-related infection were included in the final analysis. Clinical information during the drainage period was prospectively collected using standardized clinical assessment forms. These assessment forms and other medical records were retrospectively reviewed.
RESULTS
Sixty nine patients developed bacterial colonization without immediate infection during the study period. The most common cancer diagnosis was hepatocellular carcinoma (HCC), which comprise 30.4% of the population. Central venous catheters (CVCs) were inserted in 76.8% of patients and pigtail drains in 23.2% as the indwelling abdominal drain. The median duration from drain insertion to the development of bacterial colonization was 18.0 days. Staphylococci, Diphtheroid bacilliand Enterococci were the most common types of bacteria isolated during colonization. Thirty patients (43.5%) developed drain-related infection subsequently and the median time from bacterial colonization to development of infection was 14.5 days. The incidence rate of drain-related infection after bacterial colonization was 1.78 per 100-catheter days and the 1-month infection-free survival was 54.4%. Five patients (7.2%) developed peritonitis and 4 of them died from the infection episode. Decrease in body mass index (BMI) (P=0.03), having 3 or more episodes of drainage in the ascites clinic before bacterial colonization (P=0.03), presence of Escherichia coli (P=0.04) and Bacillus species (P=0.04) in surveillance ascitic fluid culture were significantly correlating with infection outcomes in univariate analyses. HCC as cancer diagnosis (OR 8.85, 95% CI: 1.86-42.07, P=0.006) and decrease in body weight (OR 1.20, 95% CI: 1.02-1.42, P=0.03) were significant factors that correlated with infection outcomes in multivariate analysis.
CONCLUSIONS
Bacterial colonization and subsequent progression into drain-related infection are common in patients on indwelling abdominal drains for malignant ascites. Staphylococci is the most common type of bacteria causing both colonization and subsequent drain-related infection. HCC and decrease in body weight are significant factors that correlate with infection outcomes after bacterial colonization.
Topics: Ascites; Bacteria; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Retrospective Studies
PubMed: 31865740
DOI: 10.21037/apm.2019.09.15 -
Journal of the National Medical... Feb 2005Cytokines play a key role in the regulation of cells of the immune system and also have been implicated in the pathogenesis of malignant diseases.
BACKGROUND
Cytokines play a key role in the regulation of cells of the immune system and also have been implicated in the pathogenesis of malignant diseases.
METHOD AND PATIENTS
We studied tumor necrosis factor-alpha, tumor necrosis factor receptor and C-reactive protein levels in both ascitic fluid and serum in patients with spontaneous bacterial peritonitis (SBP) (n = 22), and in the malignant (n = 38) and cirrhotic (n = 32) ascites.
RESULTS
C-reactive protein, tumor necrosis factor-alpha and tumor necrosis factor receptor levels in the ascitic fluid were found to be elevated in the SBP (p < 0.001) and malignant groups (p < 0.005) when compared with the sterile cirrhotic group. C-reactive protein levels in the serum were found to be elevated in the SBP group when compared with the sterile cirrhotic (p < 0.001) and malignant group (p < 0.005). Tumor necrosis factor-alpha in the serum was significantly elevated in the SBP when compared with the cirrhotic (p < 0.005) and malignant ascites (p < 0.001). Sensitivity and specificity of ascitic fluid CRP in discriminating malignant 84% and 67% and SBP from sterile ascites were 90% and 76%, respectively. Sensitivity and specificity of ascitic fluid TNF-alpha in discriminating malignant 77% and 60% and SBP from sterile ascites were 82% and 66%, respectively. Sensitivity and specificity of TNF-r p60 in discriminating malignant 74% and 70% and SBP from sterile ascites were 80% and 76%, respectively.
CONCLUSION
The sensitivity and specificity of ascitic fluid CRP, TNF-alpha and TNF-r values were found to be similar. Ascitic fluid Creactive protein to differentiate SBP and malignant ascitic from cirrhotic ascites are cheap, practical and safe tests used in the differential diagnosis of ascites.
Topics: Adult; Ascites; Ascitic Fluid; C-Reactive Protein; Cytokines; Enterococcus; Escherichia coli; Female; Humans; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Peritonitis; Receptors, Tumor Necrosis Factor; Sensitivity and Specificity; Staphylococcus aureus; Time Factors; Tumor Necrosis Factor-alpha
PubMed: 15712792
DOI: No ID Found -
Journal of Pain and Symptom Management Sep 2009The safety and efficacy of indwelling intraperitoneal (IP) catheters for the management of refractory malignant ascites is unclear. A systematic literature overview and... (Review)
Review
The safety and efficacy of indwelling intraperitoneal (IP) catheters for the management of refractory malignant ascites is unclear. A systematic literature overview and retrospective chart review of patients with malignant refractory ascites who underwent indwelling IP catheter placement was performed. Standardized literature abstraction and chart review templates were used to ensure that consistent information was collected. Fifteen publications met literature search criteria, representing 221 patients. Tenckhoff (Quinton Instrument Company, Seattle, WA, USA), Pleurex (Denver Biomedical Inc., Golden, CO, USA), and peritoneal catheters were used, along with IP ports. A median 5.9% of cases (range: 2.5%-34%) had documented peritonitis. In the literature, untunneled catheters were most commonly associated with infections. Our chart review added 19 cases from two academic institutions to this literature (median age: 60 years [range: 31-85]; females: 17 [89%]; gynecological malignancies: 14 [73%]). Palliative management before catheter placement included diuretics (n=4 [21%]) and multiple paracenteses (n=11 [58%] had two or more taps [range: 2-8]). Median time from diagnosis to catheter placement was 25 months (range: 1-77). Interventions were: French pigtail catheters (n=16 [84%]), Tenckhoff catheter (n=1 [5%]), and Port-A-Caths (Smith Medical MD, St. Paul, MN, USA) (n=2; 11%). Four (21%) catheters were tunneled. Prophylactic antibiotics were prescribed in six cases (32%). Two cases (11%) had documented infections, seven catheters (37%) became occluded, and two leaked (11%). The median time from catheter until death was 36 days (range: 4-660). Nine patients (47%) were admitted to hospice. In these retrospective studies, indwelling IP catheters appear to be a safe and effective palliative strategy to manage refractory malignant ascites, without overwhelming infection rates.
Topics: Adult; Aged; Aged, 80 and over; Ascites; Catheters, Indwelling; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Retrospective Studies
PubMed: 19328648
DOI: 10.1016/j.jpainsymman.2008.09.008 -
Cancer Science Feb 2021Peritoneal dissemination and malignant ascites in pancreatic ductal adenocarcinoma (PDAC) patients represent a major clinical issue. Lysophosphatidic acid (LPA) is a...
Peritoneal dissemination and malignant ascites in pancreatic ductal adenocarcinoma (PDAC) patients represent a major clinical issue. Lysophosphatidic acid (LPA) is a lipid mediator that modulates the progression of various cancers. Based on the increasing evidence showing that LPA is abundant in malignant ascites, we focused on autotaxin (ATX), which is a secreted enzyme that is important for the production of LPA. This study aimed to elucidate the importance of the ATX-LPA axis in malignant ascites in PDAC and to determine whether ATX works as a molecular target for treating peritoneal dissemination. In a PDAC peritoneal dissemination mouse model, the amount of ATX was significantly higher in ascites than in serum. An in vitro study using two PDAC cell lines, AsPC-1 and PANC-1, showed that ATX-LPA signaling promoted cancer cell migration via the activation of the downstream signaling, and this increased cell migration was suppressed by an ATX inhibitor, PF-8380. An in vivo study showed that PF-8380 suppressed peritoneal dissemination and decreased malignant ascites, and these results were validated by the biological analysis as well as the in vitro study. Moreover, there was a positive correlation between the amount of ATX in ascites and the degree of disseminated cancer progression. These findings demonstrated that ATX in ascites works as a promotor of peritoneal dissemination, and the targeting of ATX must represent a useful and novel therapy for peritoneal dissemination of PDAC.
Topics: Animals; Ascites; Carcinoma, Pancreatic Ductal; Female; Heterografts; Humans; Mice; Mice, Inbred BALB C; Mice, Nude; Neoplasm Invasiveness; Pancreatic Neoplasms; Peritoneal Neoplasms; Phosphoric Diester Hydrolases
PubMed: 33053268
DOI: 10.1111/cas.14689 -
Annals of Oncology : Official Journal... Oct 2001Peritonitis carcinomatosa, indicating the presence of malignant cells in the peritoneal cavity, is a well-known complication of malignant disease. As a result, so-called... (Review)
Review
Peritonitis carcinomatosa, indicating the presence of malignant cells in the peritoneal cavity, is a well-known complication of malignant disease. As a result, so-called malignant ascites develops. Malignant ascites is a debilitating condition for which no effective anti-tumor therapy is available. Frequent draining may be necessary to relieve pain and discomfort. Most studies regarding malignant ascites focus on diagnosis and treatment. In this paper. we will address the subject from a pathophysiologic perspective, using the characteristics of malignant ascites, Starling's equation of capillary forces, and recent knowledge regarding biologically active peptides produced by tumor cells. Following this approach. apart from decreased lymphatic ascites absorption, increased net capillary fluid-production can be identified as a contributing feature of ascites formation. The increased net filtration is due to an increase of overall capillary membrane-surface, increased capillary permeability and a subsequent increase of intraperitoneal protein concentration leading to increased intraperitoneal oncotic pressure. This sequence might be the result of biologically active peptides produced by tumor cells such as vascular endothelial growth factor and basic fibroblast growth factor. Interference with these mediators may serve as a target in future therapeutic strategies.
Topics: Ascites; Capillary Permeability; Endothelial Growth Factors; Fibroblast Growth Factor 2; Filtration; Hemodynamics; Humans; Lymphokines; Models, Biological; Neoplasm Metastasis; Neoplasms; Neovascularization, Pathologic; Regional Blood Flow; Vascular Endothelial Growth Factor A; Vascular Endothelial Growth Factors
PubMed: 11762804
DOI: 10.1023/a:1012504904713 -
Annals of Hepatology 2014The diagnosis of malignant ascites is a challenging problem in clinical practice, non-invasive techniques should be developed to improve diagnostic accuracy. The...
INTRODUCTION
The diagnosis of malignant ascites is a challenging problem in clinical practice, non-invasive techniques should be developed to improve diagnostic accuracy. The diagnostic performances of tumor markers in malignant ascites remained unsettled. Our aim was to evaluate diagnostic performance of tumor markers in differential diagnosis of benign and malignant ascites.
MATERIAL AND METHODS
A total of 437 patients were enrolled, and the relevant parameters of the patients were analyzed for the differentiation of benign ascites from malignant ascites.
RESULTS
At the predetermined cutoff values of tumor makers, tumor markers in ascitic fluid showed better diagnostic performance than those in serum. Combined use of tumor markers and the cytology increased the diagnostic yield of the latter by 37%. In cytologically negative malignant ascites, tumor markers provided assistance in differentiating malignant ascites from benign ascites, and the combination of ascitic tumor markers yielded 86% sensitivity, 97% specificity.
CONCLUSION
Use of a panel of tumor markers exhibited excellent diagnostic performance in diagnosing malignant ascites, which indicated the detection of tumor markers may represent a beneficial adjunct to cytology, thus guiding the selection of patients who might benefit from further invasive procedures.
Topics: Ascites; Ascitic Fluid; Biomarkers, Tumor; CA-125 Antigen; CA-19-9 Antigen; Carcinoembryonic Antigen; Cohort Studies; Diagnosis, Differential; Female; Humans; Hypertension, Portal; Liver Cirrhosis; Male; Mucin-1; Neoplasms; Prostate-Specific Antigen; Sensitivity and Specificity; alpha-Fetoproteins
PubMed: 24756011
DOI: No ID Found -
Annals of Palliative Medicine Oct 2021To analyze the clinical effect of bevacizumab combined with cisplatin in the treatment of malignant pleural effusion and ascites. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To analyze the clinical effect of bevacizumab combined with cisplatin in the treatment of malignant pleural effusion and ascites.
METHODS
A total of 86 patients with malignant pleural effusion and ascites admitted from June 2018 to September 2020 were selected as the research participants and randomly divided into a control group and observation group, with 43 cases in each group. The control group was given cisplatin intracavitary perfusion scheme, and the observation group was given bevacizumab combined with cisplatin intracavitary perfusion scheme. The Symptom Checklist 90 (SCL-90), Hamilton Depression Scale (HAM-D), and Hamilton Anxiety Scale (HAM-A) were used to evaluate participants' self-perceived negative symptoms, depression, and anxiety. The therapeutic effect and adverse reactions of the 2 groups were compared. The t-test was used for measurement data, and c2 test was used for enumeration data. Statistical significance was considered at P<0.05.
RESULTS
After treatment, the serum levels of hypoxia inducible factor-1 (HIF-1α) and vascular endothelial growth factor (VEGF) in the observation group were significantly decreased and statistically lower than those in the control group (both P<0.05); the malignant pleural and abdominal water volume, average urine volume, and average chest circumference of the observation group were improved, and the difference was statistically significant compared with the control group (all P<0.05). The scores of each factor of SCL-90 in the observation group were decreased, among which the scores of somatization, interpersonal sensitivity, depression, anxiety, hostility, and terror in the observation group were significantly lower than those in the control group (all P<0.05); after treatment, the HAMD and HAMA scores of the observation group decreased, and the scores of HAMD (13.71±5.98) and HAMA (17.62±3.98) of the observation group were significantly lower than the score of (16.52±5.75) and (21.54±4.77) of the control group (both P<0.05).
CONCLUSIONS
In the clinical treatment of malignant pleural effusion and ascites, bevacizumab combined with cisplatin intracavitary perfusion can improve the clinical treatment effect, reduce the depression and anxiety of patients, optimize patient quality of life, and improve the safety of treatment.
TRIAL REGISTRATION
Chinese Clinical Trial Registry ChiCTR2100048959.
Topics: Antineoplastic Combined Chemotherapy Protocols; Ascites; Bevacizumab; Cisplatin; Humans; Lung Neoplasms; Pleural Effusion, Malignant; Quality of Life; Treatment Outcome; Vascular Endothelial Growth Factor A
PubMed: 34763504
DOI: 10.21037/apm-21-2623