Malignant ascites drainage with indwelling abdominal catheters: can we predict and prevent infection complication?

Malignant ascites is an abnormal accumulation of fluid in the peritoneal cavity as a result of cancer. Its occurrence has been reported in numerous malignancies. Ascites is a sign of advanced disease and poor prognosis, with only 11% of patients surviving >6 months, except those with ovarian cancer. Patients with ascites experience numerous significant symptoms that deteriorate their quality of life. First-line interventions beyond treatment of the primary disease include dietary restriction, use of diuretics, and repeated paracentesis. Permanent insertion of catheters in the abdominal cavity is considered to avoid repeated paracenteses and multiple hospitalizations. Fluid drained from the peritoneal cavity can be directed evacuated outside the body, or directed to other body compartments. In the first case, evacuation of the ascitic fluid can be performed using percutaneous catheters inserted directly through the abdominal wall into the peritoneal cavity (e.g., peritoneal and venous catheters), or drains with a subcutaneous tunnel (e.g., PleurX, Tenckhoff, a peritoneal port) (1).