title: Management of symptomatic ascites and post-operative lymphocysts with an easy-to-use, patient-controlled, vascular catheter.
abstract: OBJECTIVE
  Malignant ascites (MA) can be managed with paracentesis, diuretics, shunt-systems, chemotherapy, and targeted therapies. Some treatments are ineffective; others are associated with complications, involve inpatient procedures, or are not cost-effective. Postoperative lymphocysts (LCs) are managed with inpatient drainage and sclerotherapy or surgery. We tested the use of a vascular catheter in the management of symptomatic MA and LC.
  
  
  METHODS
  Fifty-five patients with primary or recurrent cancers with ascites or LCs were managed for symptom relief. A central venous 14-Ga 16-cm catheter (Arrow) was inserted into the abdominal cavity or LC, followed by drainage.
  
  
  RESULTS
  The catheter was safely inserted with ultrasound guidance in 43 patients with MA (39 with ovarian cancer: 9 before primary cytoreduction, 30 with recurrence; 4 non-gynecological cancers), and 12 patients with LCs (10 retroperitoneal, 2 bilateral inguinal). All procedures were performed in the outpatient department under local anesthesia, without insertion-related complications. Within a mean of 30 days after catheter placement (range: 7-90 days), no grade 3 infection, peri-drain leakage, or self-removal was noted. In three patients with recurrent ovarian mucinous ascites and one patient with an inguinal LC, some drain obstruction was noted. In cases before primary cytoreduction for ovarian cancer, drainage enabled better nutritional and anesthiological outcomes. Patients with chronic ascites were able to self-monitor the amount of evacuated fluid. Twelve patients whose ascites were drained had chemotherapy at the time, and they reported better well-being, and we estimated better performance status. LC drainage followed by sclerotherapy enabled symptom control and LC radical treatment.
  
  
  CONCLUSIONS
  The use of the vascular catheter is safe, easy, and cost-effective in the management of symptomatic MA and LC.
authors.affiliation: Gdynia Oncology Center, Department of Gynecologic Oncology, Poland. Electronic address: maciej.stukan@gmail.com.
authors.forename: Maciej
authors.initials: M
authors.lastname: Stukan
authors.affiliation: Gdynia Oncology Center, Department of Clinical Oncology, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Leśniewski-Kmak
authors.affiliation: Gdynia Oncology Center, Department of Clinical Oncology, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Wróblewska
authors.affiliation: Gdynia Oncology Center, Department of Gynecologic Oncology, Poland.
authors.forename: Mirosław
authors.initials: M
authors.lastname: Dudziak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000209:etiology / Q000628:therapy*; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D062905:Central Venous Catheters; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008210:Lymphocele / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000601:surgery; D011183:Postoperative Complications / Q000628:therapy*; D011446:Prospective Studies; D012648:Self Care; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: Ascites; Catheter; Drainage; Lymphocyst; Management; Symptom