• Tetsuya Ito, Naosuke Yokomichi, Hiroto Ishiki, Takashi Kawaguchi, Ken Masuda, Hiroaki Tsukuura, Hiromi Funaki, Kozue Suzuki, Kiyofumi Oya, Jun Nakagawa, Masanori Mori, and Takuhiro Yamaguchi.
• Department of Palliative Care, Japanese Red Cross Medical Center, Tokyo, Japan; Department of Palliative Medicine and Advanced Clinical Oncology, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan.
• J Pain Symptom Manage. 2021 Nov 1; 62 (5): 968-977.

ContextPatients with malignant ascites often suffer from distressing symptoms, especially in their end-of-life stage. Although paracentesis is the most common treatment modality to alleviate such symptoms, the optimal volume of paracentesis is not known.ObjectivesTo explore the efficacy and safety of paracentesis by the drainage volume for terminally ill cancer patients with malignant ascites.MethodsThis was part of a multicenter prospective observational study (EASED study). Consecutive adult patients with advanced cancer admitted to 23 participating palliative care units were eligible. We analyzed patients with malignant ascites who received paracentesis. We compared paracentesis-free survival (PFS) using Cox regression among three groups with different paracentesis volumes: minimum: ≤ 1500 mL, small: 1500-2500 mL, and moderate: > 2500 mL. Trends of the difference in the numerical rating scale of abdominal distension (0-10) and adverse events were compared among the 3 groups.ResultsOf the 1926 patients enrolled, 673 developed ascites (symptomatic, n = 374 and asymptomatic, n = 299). Finally, we analyzed 87 patients with paracentesis. Median PFS was 7 days. Compared with a moderate volume, small-volume paracentesis was not a significant risk for shorter PFS (HR: 1.14, 95% CI: 0.69-1.93), while a minimum volume was a significant risk (HR: 2.34). The abdominal distension intensity significantly decreased after paracentesis (median: 7.5 to 4.0), while the difference did not significantly increase as the volume of paracentesis rose (P = 0.61). No severe adverse event was observed.ConclusionEven small-volume paracentesis could alleviate abdominal distension of terminally ill cancer patients with malignant ascites without shortening the paracentesis interval compared with moderate-volume paracentesis. Small-volume paracentesis was a well-balanced treatment for these patients.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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