Continuous low flow ascites drainage through the urinary bladder via the Alfapump system in palliative patients with malignant ascites.

Fotopoulou, Christina; Berg, Thomas; Hausen, Annekristin; Hennig, René; Jalan, Rajiv; Malagó, Massimo; Capel, Jeroen; De Gottardi, Andrea; Stirnimann, Guido (2019). Continuous low flow ascites drainage through the urinary bladder via the Alfapump system in palliative patients with malignant ascites. BMC Palliative Care, 18(1), p. 109. BioMed Central 10.1186/s12904-019-0497-3

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BACKGROUND Malignant Ascites (MA) is a therapeutic dilemma significantly impairing patients' quality of life (QoL). The Sequana Medical alfapump System (AP), a subcutaneous, externally rechargeable, implantable device, continually draining ascites via the urinary bladder, has been well established in liver cirrhosis, but not yet in MA. The AP-system was evaluated in cancer patients in reducing the need for large volume paracentesis (LVP). METHODS A retrospective multicentre evaluation of all eligible patients who received an AP for MA-palliation was performed. AP was evaluated for its ability to reduce LVP and cross-correlated with adverse events (AE), survival and retrospective physician-reported QoL. RESULTS Seventeen patients with median age of 63 years (range: 18-81), 70.6% female, across 7 primary tumour types were analysed. Median duration of AP-implantation was 60 min (range: 30-270) and median post-implantation hospital stay: 4 days (range: 2-24). Twelve protocol-defined AE occurred in 5 patients (29.4%): 4 kidney failures, 4 pump/catheter-related blockages, 3 infections/peritonitis and 1 wound dehiscence. Median ascitic volume (AV) pumped daily was 303.6 ml/day (range:5.6-989.3) and median total AV drained was 28 L (range: 1-638.6). Median patient post-AP-survival was 111 days (range:10-715) and median pump survival was 89 days (range: 0-715). Median number of paracenteses was 4 (range: 1-15) per patient pre-implant versus 1 (range: 0-1) post-implant (p = 0.005). 71% of patients were reported to have an improvement of at least one physician reported QoL-parameters. CONCLUSIONS AP appears to be effective in palliating patients with MA by an acceptable morbidity profile. Its broader implementation in oncology services should be further explored. TRIAL REGISTRATION NCT03200106; June 27, 2017.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology

UniBE Contributor:

De Gottardi, Andrea and Stirnimann, Guido

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1472-684X

Publisher:

BioMed Central

Language:

English

Submitter:

Thi Thao Anh Pham

Date Deposited:

08 Jan 2020 09:47

Last Modified:

12 Jan 2020 02:43

Publisher DOI:

10.1186/s12904-019-0497-3

PubMed ID:

31805921

Uncontrolled Keywords:

Ascites Carcinomatosis Palliative care Pathologic processes Quality of life Retrospective studies

BORIS DOI:

10.7892/boris.137301

URI:

https://boris.unibe.ch/id/eprint/137301

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