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Efficacy and safety of reinfusion of concentrated ascitic fluid for malignant ascites: a concept-proof study

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Abstract

Purpose

Malignant ascites is one of the symptoms causing discomfort in advanced cancer patients. Cell-free and concentrated ascites reinfusion therapy (CART) is one treatment modality, but controlled trials are limited. The primary aim of this study was to explore the efficacy and safety of CART, as well as their predictors, to obtain data for planning a further controlled trial.

Methods

This was a single center retrospective cohort study in patients with refractory malignant ascites. Consecutive adult patients who underwent CART were enrolled. The primary endpoints were the time to next paracentesis and seven patient-reported symptoms (e.g., abdominal pain and distension). The secondary endpoints were adverse events, laboratory findings, and physical findings.

Results

A total of 104 CART procedures for 51 patients were analyzed. The median time to next paracentesis was 27 days (95% CI, 21–35). Intensities of all seven symptoms were significantly improved after CART (p < 0.0001 for all symptoms). Grade 3 hypotension occurred during one procedure, and mild fever occurred in 5%. Total protein, albumin, and estimated glomerular filtration rate were significantly increased. Hemorrhagic ascites, ascites white blood cell count, serum total protein, and lymphocyte percentages were the independent predictors of the time to next paracentesis.

Conclusion

The effects of reinfusion of concentrated ascitic fluid may be maintained for 1 month, being potentially longer than that of total paracentesis alone. This study had no comparison groups and examined the short-term effect. A randomized controlled study to compare the long-term effects of total paracentesis alone vs. CART is necessary.

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Funding

This study was supported by Japan Society for the Promotion of Science KAKENHI Grant Number JP16H05212.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Palliative Care, Nissay Hospital, Osaka, Japan

    Rumi Hanada

  2. Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan

    Naosuke Yokomichi

  3. Clinical Engineering Laboratory, Division of Central Clinical Research Laboratory, Nissay Hospital, Osaka, Japan

    Chihiro Kato & Kazumi Miki

  4. Department of Nursing, Nissay Hospital, Osaka, Japan

    Sachiko Oyama

  5. Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan

    Tatsuya Morita

  6. Department of Palliative Care, Hoshigaoka Medical Center, Osaka, Japan

    Ryoko Kawahara

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  1. Rumi Hanada
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Corresponding author

Correspondence to Naosuke Yokomichi.

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The study was approved by the institutional review board of Nissay General Hospital.

Conflict of interest

The authors declare that they have no conflict of interest.

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Hanada, R., Yokomichi, N., Kato, C. et al. Efficacy and safety of reinfusion of concentrated ascitic fluid for malignant ascites: a concept-proof study. Support Care Cancer 26, 1489–1497 (2018). https://doi.org/10.1007/s00520-017-3980-5

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  • DOI: https://doi.org/10.1007/s00520-017-3980-5

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