Paracentesis is a procedure to drain excess fluid, called ascites, from the abdomen. Ascites is a common symptom of peritoneal mesothelioma. Fluid buildup may cause stomach pain and breathing difficulty. Doctors use paracentesis to diagnose the cause of the buildup and provide symptom relief.

01. Paracentesis for Mesothelioma

What Is Paracentesis for Mesothelioma?

Mesothelioma paracentesis procedures drain fluid from the abdominal cavity. The minimally invasive surgery relieves patient pain stemming from excess fluid (ascites). As little as two tablespoons of fluid (25 mL) in the peritoneal cavity qualifies as ascites.

In healthy individuals, a small amount of fluid lubricates the layers of the peritoneum (lining of the abdominal wall). Excess peritoneal fluid is a common symptom of peritoneal mesothelioma. The mesothelioma tumors may block the reabsorption of peritoneal fluid, leading to fluid buildup.

The excess fluid, called peritoneal effusion, may cause stomach pain and breathing difficulty.

What Is Paracentesis?

Paracentesis is the removal of abdominal fluid buildup with a hollow needle. There are about 150,000 paracentesis procedures completed per year in the United States.

How Does Paracentesis Relieve Symptoms?

Paracentesis relieves patient symptoms by draining the excess fluid causing discomfort. A paracentesis procedure is not a permanent solution but offers patients temporary relief from peritoneal effusion. Peritoneal mesothelioma patients may undergo repeated paracentesis for symptom management.

Peritoneal mesothelioma is not the only disease that causes fluid buildup in the abdomen. Fluid buildup is a symptom of many other diseases, such as abdominal cancers and cirrhosis. Doctors can use fluid from a paracentesis procedure to diagnose other diseases.

However, ascitic fluid analysis cannot diagnose mesothelioma. The cancer can only be diagnosed through a tissue biopsy.

Diseases That May Cause Ascites
  • Abdominal cancer (any cancer in the abdomen)
  • Alcoholism/alcohol abuse
  • Cirrhosis
  • Congestive heart failure
  • Hepatitis B
  • Hepatitis C
  • Kidney failure
  • Peritoneal mesothelioma

What’s the Difference Between Paracentesis and Thoracentesis?

Paracentesis treats patients with excess abdominal fluid (peritoneal effusion). Thoracentesis treats patients with excess lung fluid (pleural effusion).

Fluid accumulation is a common symptom for many malignant mesothelioma patients. In peritoneal mesothelioma patients, the fluid accumulates between the layers of the peritoneum in the abdominal cavity. Paracentesis treats the symptom.

For malignant pleural mesothelioma patients, fluid accumulates between the layers lining the lung or pleural cavity. This fluid is removed through thoracentesis or pleurodesis.

Paracentesis and thoracentesis are minimally invasive and remove the excess fluid through needle aspiration. Doctors will perform the appropriate procedure based on where the fluid accumulates.

Treatments to Remove Abdominal Fluid

There is one common treatment for abdominal fluid. The procedure may be called three different names:

  • Paracentesis
  • Ascitic tap
  • Abdominal tap
Treatments to Remove Lung Fluid

Fluid in the lungs is commonly removed through two different procedures:

  • Thoracentesis/Pleurocentesis
  • Pleurodesis
02. Paracentesis Procedure

What to Expect During a Paracentesis Procedure

The mesothelioma paracentesis procedure is a minimally invasive surgery. The minor surgical procedure is often done on an outpatient basis. Doctors may repeat the procedure as needed to manage patient symptoms.

The goal of all paracentesis procedures is to remove excess fluid from the abdomen. Doctors perform the procedure as a palliative mesothelioma treatment. The goal of palliative treatments is to lessen symptoms and improve quality of life. When performed for symptom relief, doctors typically attempt to remove all the excess fluid. Patients undergoing the procedure for other reasons, such as diagnostic purposes, may have less fluid removed.

Whether completed for diagnostic or palliative purposes, the procedure should be relatively painless. To ease pain, doctors apply a local anesthetic to the patient’s abdomen. This topical painkiller lessens the pain felt during needle insertion.

Steps of the Paracentesis Procedure

  1. The patient is positioned to make the procedure as safe and effective as possible.
  2. The doctor may use an ultrasound to identify the optimal needle placement.
  3. The patient’s skin and underlying tissues are numbed.
  4. The doctor inserts a needle into the abdomen to access the fluid.
  5. A syringe or other medical device is attached to the needle and draws out the fluid.
  6. Once the desired amount of fluid is drained, the doctor removes the needle and syringe. Patients may receive small sutures if needed.

Diagram of the Paracentesis Procedure

When removing a large amount of fluid, some patients may experience low blood pressure. The decrease in blood pressure may result in dizziness. Malignant peritoneal mesothelioma patients may receive intravenous (IV) fluids during the procedure. The IV fluids prevent low blood pressure following paracentesis.

Typically, a paracentesis takes about 30 minutes to complete. Patients may undergo the minor procedure at cancer centers and hospitals across the country or in a doctor’s office.

Often, a gastroenterologist performs the procedure. However, mesothelioma patients may have a specialized mesothelioma doctor conduct the paracentesis.

03. Benefits of Paracentesis

Benefits of Paracentesis for Mesothelioma Patients

Paracentesis for mesothelioma is a relatively low-risk procedure. As such, paracentesis may be a viable treatment for many peritoneal mesothelioma patients with ascites.

Ascites may recur and continue to cause symptoms such as abdominal pain. The palliative procedure can be repeated as needed to reduce the abdominal pain and discomfort caused by the fluid. The frequency of paracentesis varies on a case-by-case basis.

If ascites is a recurring problem for patients, their medical team may instead insert a catheter into the patient’s peritoneal cavity. A catheter enables continuous draining of the peritoneal fluid.

According to a 2019 study from Wake Forest Baptist Medical Center, researchers found the most common complaint leading to a peritoneal mesothelioma diagnosis is abdominal pain and/or swelling. For most peritoneal mesothelioma patients, these abdominal symptoms stem from ascites. Treating the buildup of fluid with paracentesis may improve patient quality of life.

04. Paracentesis Risks

Paracentesis Risks and Complications

There are few risks and complications involved with paracentesis. This palliative procedure does not prevent ascites from returning. There is no cure for ascites caused by peritoneal mesothelioma.

Risk of complications may increase if a patient moves during the procedure. If the patient is unable to hold the position, a physician may end the procedure early. This way, the needle will not damage or perforate nearby organs due to position changes. If the procedure does end early, doctors may not be able to remove the desired amount of fluid.

Side effects of the procedure are mild and infrequent.

Side Effects of Paracentesis
  • Bleeding and/or hemorrhage
  • Fluid leakage from the insertion site
  • Hematoma (pooling of blood under the skin)
  • Hypotension (low blood pressure)
  • Infection
  • Intestinal perforation (rare)

Some peritoneal mesothelioma patients may also experience other paracentesis complications. For instance, those with co-occurring lung conditions may be more at risk for side effects.

In one case study, researchers reported a patient with peritoneal mesothelioma and chronic obstructive pulmonary disease (COPD). The 62-year-old patient experienced serious complications following paracentesis.

  • The patient experienced pneumothorax (partial or complete lung collapse) twice.

The complication is very rare and only described in a couple of cases. Patients should discuss all treatment options for their individual cases, including risks and benefits, with their medical team.

05. Paracentesis Eligibility

Who Can Be Treated With Paracentesis?

Any eligible patient experiencing a buildup of ascitic fluid may undergo paracentesis for symptom management. The procedure is minimally invasive. As such, paracentesis may be an option for patients with any stage of mesothelioma.

Paracentesis may treat peritoneal mesothelioma patients with ascites, as well as other patients experiencing the symptom. Due to the wide applicability of the procedure, it is available at most hospitals.

Patients experiencing abdominal discomfort should talk to their doctor about potential causes. Once diagnosed with ascites, paracentesis may be a beneficial palliative treatment option.