Dr. Praneeth SuvvariBasavatarakam Indo-American Cancer Hospital and Research Institute, India
Title: Management of malignant ascites by indwelling tunnelled catheters in Indian setup: A case series
Introduction: Malignant Ascites (MA) poses significant symptom burden at end of life in patients with advanced neoplasms. Indwelling Tunnelled Catheters (ITC) are designed to remain in situ for the remaining lifespan of the patient and permit home drainage. 9 patients with MA requiring repeated paracentesis were selected for ITC insertion. Patients and caregivers were initially counselled on the advantages of ITC and the costs of insertion. Insertion procedure: Small incision was given at needle insertion site and after serial dilatation of the tract, a dilator, tear away sheath assembly was placed in the peritoneal cavity over the stiff guide wire. A second incision was made approximately 5 cm superolateral to the first incision. The metal tunneling device was advanced through the tract with the peritoneal catheter attached to its backside. The catheter was placed in the most dependent part of the pelvic cavity through the peel-away sheath, and then, the peel-away sheath was removed. The skin was closed with primary suturing and protective dressing was applied. Results: 2 out of 9 patients succumbed to their illness within a week of insertion. The common complications were pericatheter leak and discomfort on lying down on inserted side. Most of the patients were comfortable till death with the catheter insitu. Conclusion: ITC are a suitable option to manage symptoms in patients with terminal Malignant Ascites. Careful patient selection and proper education of the caregivers will increase the success rate of procedures. Drawbacks of ITC are its high costs, limited availability and expertise needed to perform the procedure. Patients should be counseled regarding possibility of pericatheter leaks which is although distressing and can be managed by conservative measures.
Praneeth Suvvari has been working as a consultant in Onco-anaesthesia, pain, and palliative medicine department for the past 3 years at Basavatarakam Indo-American Cancer Hospital and Research Institute (BIACH & RI), Hyderabad, India. He is a faculty and tutor to DNB palliative medicine students at his institute. He has academic credentials like MD in Anaesthesia, DM in Onco-Anaesthesia, and certifications in Palliative Medicine like CCEPC, CTC, and NFPM to his credit. He is passionate to work and teach his students and colleagues.