Paracentesis for Mesothelioma

What Is a Paracentesis?

Paracentesis is an outpatient procedure that uses a hollow needle to drain ascites fluid from the abdomen, most often performed to relieve pressure and pain in peritoneal mesothelioma patients. This minor surgery provides relief and can improve patients’ comfort.

Inside your abdomen is a lining separating your organs from the abdominal wall. Normally, there is a small amount of fluid between these layers. Fluid in the peritoneal cavity is called ascites or peritoneal effusion if it exceeds an ounce (30 ml). This fluid is known as ascitic fluid.

Quick Facts About Paracentesis

• Helps drain excess fluid from the abdominal lining
• Provides temporary relief from abdominal discomfort
• Less invasive than many other surgical options
• Typical procedure duration: 20 to 45 minutes, but large-volume paracentesis can be done over the course of up to 4 to 6 hours 
• Typical drainage volume: typically 1 to 5 liters per session, though LVP can drain 5 to 10 (sometimes 15 to 20) liters 
• Usually done as an outpatient procedure
• Standard recovery window: discharge usually is within 1 to 2 hours, and rest at home is usually advised for the first 24 hours 
• Technical drainage success rate: above 98%, according to the American Journal of Medicine 

When too much ascitic fluid builds up, it can create pressure on your abdominal organs and diaphragm. This buildup may happen for various reasons, such as infection, injury, liver issues or cancer. Ascites is often seen in cases of peritoneal mesothelioma.

If the goal is to identify the cause of the ascites, a doctor might take as little as 50 mL of fluid for testing. In therapeutic paracentesis, a doctor may remove a liter of fluid or more to provide relief. A report in Case Reports in Radiology suggested that paracentesis can also enhance the clarity of imaging tests, making it a valuable procedure for diagnosis and treatment.

Can a Paracentesis Diagnose Mesothelioma?

Paracentesis can be a helpful procedure for relieving some of the discomfort peritoneal mesothelioma can cause, but it’s not the best way to diagnose this rare cancer. Sometimes, even when cancer is present, the cells found in the ascitic fluid can appear normal. This is why doctors often need to perform a biopsy, which involves taking a small tissue sample for closer examination instead of relying solely on the fluid analysis.

People with peritoneal mesothelioma often experience ascites or peritoneal effusion. This happens because the cancer can lead to a condition called peritoneal carcinomatosis. In this condition, tumors can damage the lining of the abdomen and block the flow of fluids. Additionally, they can weaken the cells in the abdominal wall, which normally help keep proteins and fats from leaking out of blood vessels into the abdomen. 

While ascites is a common sign of peritoneal mesothelioma, it doesn’t always mean the cancer has spread beyond the abdomen. It can result from local tumor damage to the peritoneal lining.

Epifanio Figueroa

Verified Asbestos.com Survivor

Ascites Leads to Peritoneal Mesothelioma Diagnosis

Epifanio says his symptoms began when his stomach started swelling and wouldn’t stop. He went to a doctor who told him fluid was accumulating in his peritoneal cavity. The condition is known as peritoneal effusion or ascites. The peritoneal fluid can collect in the abdomen causing swelling or pain. “So we went to a hospital called Memorial West in Florida and from there they told us they weren’t sure,” Epifanio recounted. “So we went to Cleveland Clinic and they diagnosed me with mesothelioma. That was in 2016.”

Epifanio Figueroa

Verified Asbestos.com Survivor

Read Epifanio’s Story

Palliative Paracentesis Benefits and Alternatives

Paracentesis is a palliative treatment. This means it helps relieve symptoms, and it can improve quality of life, no matter what stage a patient is in. It’s also an easy procedure that allows you to go home the same day.

If the fluid collects in smaller areas of the abdomen (becomes loculated), a paracentesis may not work. The procedure also doesn’t stop ascites from coming back. Because recurrence of peritoneal effusions after paracentesis is common, doctors often leave a catheter in place for continuous drainage of the fluid, which can be done at home. 

There isn’t a set limit on how many paracentesis procedures a patient can have. For some mesothelioma patients, procedures may need to happen every 1 to 2 weeks. Each session that removes a large volume of fluid typically includes an albumin infusion, delivering a human liver protein via IV, to protect blood pressure and circulatory function.

Paracentesis is highly effective at removing abdominal fluid. Studies show a technical success rate greater than 98% for the drainage procedure itself. A review from 2016 found that surgery combined with heated chemo successfully controls ascites in more than 90% of patients.

Expert Insight

A paracentesis is a safe and effective way of removing unwanted fluid buildup in the abdominal area. Your doctor may suggest this procedure to relieve abdominal pressure, and it can often help to understand why it accumulated. It only takes about a half hour and causes minimal discomfort.

Karen Selby, R.N. , Patient Advocate at The Mesothelioma Center

Surgical Consultation for Paracentesis

If you believe paracentesis could be a good choice for your mesothelioma, consider meeting with the surgeon and their team to find out more. During this consultation, you will have the chance to meet the surgeon and their skilled team.

They will review your medical history to help determine if this procedure is right for you. This is also a great time for you to ask questions or share any concerns about paracentesis.

The surgical team will provide all the important information you need to prepare for the procedure and recover afterward. These consultations are vital in ensuring that patients are ready for surgery and feel supported throughout the process. You can have your consultation in person or through a video call, whichever works best for you.

FREE MESOTHELIOMA TREATMENT GUIDE

Expert Guidance for Your Mesothelioma Journey

Get answers about treatment, top doctors, and clinical trials from the nation’s most trusted mesothelioma resource.

Get Your Free Guide

The Paracentesis Procedure

Paracentesis is an outpatient procedure that usually takes about 20 to 45 minutes, though LVP can take longer. Doctors use an ultrasound beforehand to confirm how much fluid has built up and where. You’ll lie on a bed tilted at a 45-degree angle, which helps fluid gather in the lower abdomen, and you’ll empty your bladder before the procedure begins.

5 Steps of a Paracentesis 

• Step 1: Your doctor cleans the insertion site and applies a local anesthetic.
• Step 2: Once the anesthetic takes effect, you’ll likely feel little to no pain during needle insertion. The most common sensation is pressure or a pulling feeling as fluid moves out. Some people report mild cramps when larger volumes drain.
• Step 3: Fluid drains using gravity, a syringe, or a vacuum bottle. Fluids are drained with your care team’s guidance to help your body balance fluids and electrolytes. Typically 1 to 5 liters are drained, but 5 to 1o (sometimes as much as 15 to 20) liters are drained with LVP.
• Step 4: If a large volume is removed, you may receive a serum albumin infusion to replace what was lost, stabilize blood pressure and reduce the risk of shock.
• Step 5: Once enough fluid is drained, your doctor covers the insertion site with a sterile dressing. If the procedure needs repeating, a catheter with a flow-control valve may be left in place.

Your care team will monitor you closely throughout the procedure and adjust as needed. The entire process, from preparation to discharge, typically takes 2 to 4 hours, though it can be longer for LVP. 

Recovery and Aftercare

Most paracentesis patients recover in 1 to 2 hours after the procedure and return home the same day. It’s usually recommended to rest for the first 24 hours after the procedure, and many people return to normal activity the next day. Many people notice their abdomen feels softer right away.

Mild soreness at the insertion site is normal for the first day or two. A small amount of fluid may also seep from the site, so keep it clean and covered with the sterile dressing provided. 

Contact your care team if you develop a fever, worsening pain, redness or feel lightheaded. A follow-up appointment is typically scheduled to review lab results from the drained fluid, check the puncture site for signs of infection or leakage and monitor for fluid returning. If fluid does return, the care team uses that information to decide whether repeat procedures or medication adjustments are needed.

How Paracentesis Compares to Similar Procedures

Paracentesis is one of several procedures used to drain fluid that has accumulated in body cavities from mesothelioma or other advanced cancers. The procedures aren’t interchangeable. Each targets a specific cavity, serves a defined purpose and fits a particular patient profile.

Thoracentesis and pleurodesis address pleural effusion, or fluid around the lungs, while paracentesis and peritoneal interventions address ascites, or fluid in the abdomen. Peritonectomy with HIPEC stands apart as a surgical procedure with curative intent, appropriate only for eligible patients with peritoneal mesothelioma.

New table:

While paracentesis works well for most mesothelioma patients, it’s contraindicated in some cases. For example, people with severe clotting disorders or bowel obstruction may need those issues corrected first. An active skin infection at the insertion site can delay the procedure. Loculated fluid may mean image-guided drainage is needed instead. Your physician will assess if paracentesis is right for you.

Risks and Complications

Major complications from paracentesis are uncommon, with serious adverse events reported in fewer than 1% of cases. If concerns come up before or after the procedure, a doctor can help weigh the specific risks involved.

Rare Complications of Paracentesis

• A persistent leak from the insertion site
• Abdominal wall hematoma (a collection of blood outside a blood vessel)
• Hypotension (low blood pressure)
• Infection
• Perforation of the small or large intestine, stomach or bladder

One rare complication noted in a patient with peritoneal mesothelioma was the repeated occurrence of pneumothorax after the procedure. A pneumothorax happens when air builds up in the space around the lungs, which can prevent them from expanding fully. Although this is uncommon, doctors recommend considering it for patients with existing lung issues.

While paracentesis works well for most mesothelioma patients, it’s contraindicated in some cases. For example, people with severe clotting disorders or bowel obstruction may need those issues corrected first. An active skin infection at the insertion site can delay the procedure. Loculated fluid may mean image-guided drainage is needed instead. Your physician will assess if paracentesis is right for you.

Frequently Asked Questions About Paracentesis

Is paracentesis painful?

A local anesthetic numbs the insertion site before the needle goes in, so significant pain is uncommon. Most patients describe pressure or pulling as fluid drains, and mild cramping can occur when larger volumes are removed.

How often can paracentesis be performed?

There’s no fixed limit on how many times paracentesis can be performed. For some people diagnosed with mesothelioma who have recurring ascites, doctors may repeat the procedure every 1 to 2 weeks. In some cases, a catheter is placed for continuous home drainage.

How much fluid is removed during paracentesis?

A diagnostic paracentesis may remove as little as 50 mL of fluid for laboratory testing. A therapeutic paracentesis typically removes 1 to 5 liters. A large-volume paracentesis typically removes 5 to 10 liters, but can remove more than 20 liters depending on the severity and cause of the ascites.

Does Paracentesis Cure Ascites?

Paracentesis is usually considered a symptom-management or palliative procedure. It can be seen as essentially curative when it removes fluid from a temporary infection or injury, removing the fluid and allowing the body to heal. Fluid doesn’t typically recur in these instances. However, in chronic conditions or malignancies like mesothelioma, recurrence is common, so the procedure isn’t considered curative. Many people diagnosed with mesothelioma receive repeat procedures or an indwelling drainage catheter.

What’s the difference between paracentesis and thoracentesis?

Paracentesis drains fluid from the abdominal cavity and thoracentesis drains fluid from the chest cavity around the lungs. The procedures are similar in technique but treat different mesothelioma presentations: paracentesis is for peritoneal mesothelioma and thoracentesis is for pleural mesothelioma.

Recommended Reading