Palliative semi-permanent abdominal drain for the management of refractory malignant ascites: a retrospective study in a comprehensive cancer center

Purpose: Refractory malignant ascites in the advanced palliative phase significantly impacts patients’ quality of life (QoL), causing pain, respiratory difficulties, digestive issues, and impaired mobility. While iterative drainages can effectively relieve symptoms, frequent hospital visits and the significant volume of fluid requiring removal pose considerable challenges. A semi-continuous approach using a permanent bedside drain may offer more frequent drainages of smaller volumes. This study aimed to examine the feasibility, reliability, and safety of a semi-permanent bedside abdominal drain for patients in advanced palliative care with refractory malignant ascites. Methods: This is a retrospective study, with cases identified through computerized queries of digital patient records. Data collected included patient characteristics, biological parameters, procedure details, and end-of-life outcomes. Results: Between 2019 and 2024, this drain was proposed to 25 palliative care patients. They had received a median of three lines of oncological treatment, with 60% of them receiving exclusively palliative care at the time of drainage. Drain placement had a beneficial impact on disabling symptoms in over 92% of cases, allowing 60% of patients to return to home hospitalization, without requiring additional hospital visits for paracentesis. The median time between drain placement and end of life was 36.5 days [4;147], while the median time from the diagnosis of refractory ascites to death was 93.7 days [14;263]. Conclusion: A non-tunneled semi-permanent catheter, easily implanted at the patient’s bedside, may improve QoL. This study serves as a pilot for a prospective cohort that will analyze QoL improvements and economic costs.