Abstract

Background

Ascites is the accumulation of fluid within the abdominal cavity. Most women with advanced ovarian cancer and some women with advanced endometrial cancer need repeated drainage for ascites. Guidelines to advise those involved in the drainage of ascites are usually produced locally and are generally not evidence‐based. Managing drains that improve the efficacy and quality of the procedure is key in making recommendations that could improve the quality of life (QoL) for women at this critical period of their lives.

Objectives

To evaluate the effectiveness and adverse events of different interventions for the management of malignant ascites drainage in the palliative care of women with gynaecological cancer.

Search methods

We searched CENTRAL, MEDLINE, and Embase to 4 November 2019. We checked clinical trial registries, grey literature, reports of conferences, citation lists of included studies, and key textbooks for potentially relevant studies.

Selection criteria

We included randomised controlled trials (RCTs) of women with malignant ascites with gynaecological cancer. If studies also included women with non‐gynaecological cancer, we planned to extract data specifically for women with gynaecological cancers or request the data from trial authors. If this was not possible, we planned to include the study only if at least 50% of participants were diagnosed with gynaecological cancer.

Data collection and analysis

Two review authors independently selected studies, extracted data, evaluated the quality of the included studies, compared results, and assessed the certainty of the evidence using Cochrane methodology.

Main results

In the original 2010 review, we identified no relevant studies. This updated review included one RCT involving 245 participants that compared abdominal paracentesis and intraperitoneal infusion of catumaxomab versus abdominal paracentesis alone. The study was at high risk of bias in almost all domains. The data were not suitable for analysis. The median time to the first deterioration of QoL ranged from 19 to 26 days in participants receiving paracentesis alone compared to 47 to 49 days among participants receiving paracentesis with catumaxomab infusion (very low‐certainty evidence). Adverse events were only reported among participants receiving catumaxomab infusion. The most common severe adverse events were abdominal pain and lymphopenia (157 participants; very low‐certainty evidence). There were no data on the improvement of symptoms, satisfaction of participants and caregivers, and cost‐effectiveness.

Authors' conclusions

Currently, there is insufficient evidence to recommend the most appropriate management of drainage for malignant ascites among women with gynaecological cancer, as there was only very low‐certainty evidence from one small RCT at overall high risk of bias.

Author(s)

Chumnan Kietpeerakool, Siwanon Rattanakanokchai, Nampet Jampathong, Jatupol Srisomboon, Pisake Lumbiganon

Abstract

Plain language summary

Methods for the drainage of fluid containing cancer cells that collect in the abdomen in women with gynaecological cancer

Background

Malignant ascites is the build‐up of fluid within the abdominal cavity caused by underlying cancer. Women with advanced ovarian cancer and some women with advanced uterine cancer (also known as womb cancer) often need drainage for malignant ascites to alleviate discomfort. Guidelines to advise healthcare professionals involved in the drainage of ascites are usually produced locally and are generally based on clinicians' experience.

Study characteristics

We searched for studies up to Novemeber 2019 that compared different ways of managing the drainage of fluid collected in the abdomen of women with gynaecological cancer (cancer that starts in a woman's reproductive organs).

Key results and quality of evidence

The original 2010 review found no relevant studies. This updated review included one randomised controlled trial (RCT: a type of study in which people are randomly assigned to receive different treatments) involving 245 women that compared drainage combined with catumaxomab (a medicine used to treatment malignant ascites) versus drainage alone. However, the results were insufficient to assess the difference between these treatments. Although women receiving drainage combined with catumaxomab had better quality of life (the general well‐being of a person) for longer compared to drainage alone, we are very unsure of this evidence due to the small number of participants and trials. There were some side effects in the drainage plus catumaxomab group (e.g. pain, low white blood cell count), but they were not well reported. At present, there is insufficient data regarding the best management of drainage for malignant ascites among women with gynaecological cancer.

The evidence is current to 4 November 2019.

Author(s)

Chumnan Kietpeerakool, Siwanon Rattanakanokchai, Nampet Jampathong, Jatupol Srisomboon, Pisake Lumbiganon

Reviewer's Conclusions

Authors' conclusions 

Implications for practice 

Currently, there is not enough evidence to make recommendations regarding the management of drainage for malignant ascites among women with gynaecological cancer. Although combined abdominal paracentesis and intraperitoneal infusion of catumaxomab may delay the deterioration of QoL among adults with malignant ascites compared to abdominal paracentesis alone, the certainty of this evidence is very low. In addition, catumaxomab is currently unavailable.

Implications for research 

This review indicates that the research assessing appropriate management of drainage for malignant ascites among women with gynaecological cancer remains hugely under‐resourced despite the incidence of malignant ascites in gynaecological cancer is disproportionately high compared to other cancer types (Becker 2006; Mackey 1996; Wilailak 1999).

High‐quality randomised controlled trials are needed to assess the effective intervention for drainage for malignant ascites in women with gynaecological cancer. Particular attention should be given to the comparison of repeat abdominal paracentesis, the most commonly used procedure, versus other advanced drainage procedure (i.e. the insertion of permanent tunnelled catheters and peritoneo‐venous shunts). Adding a pharmacological intervention to a mechanical drainage procedure in order to diminish reaccumulation of ascites also merits attention in future research. Any studies should include an assessment of the effect of intervention on quality of life, cost‐effectiveness, adverse events, and satisfaction of participant and caregiver to adequately provision of information for considering the risks and benefits of the interventions to be used among the terminally ill adults and their caregivers.

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