Paracentesis for Mesothelioma

What Is Paracentesis for Mesothelioma?

Mesothelioma paracentesis procedures drain fluid from the abdominal cavity. Fluid buildup in the abdominal cavity is known as peritoneal effusion or ascites. Paracentesis is a minimally invasive procedure to address ascites.

Doctors may perform paracentesis for two primary reasons: diagnostic and therapeutic. Diagnostic paracentesis can help determine the underlying cause of the fluid buildup. Therapeutic paracentesis can help relieve uncomfortable symptoms caused by fluid buildup, including abdominal pain, swelling and difficulty breathing.

In healthy individuals, a small amount of fluid lubricates the layers of the peritoneum (lining of the abdomen). However, excess peritoneal fluid is a common symptom of peritoneal mesothelioma. The mesothelioma tumors may block the reabsorption of peritoneal fluid, leading to fluid buildup. Ascites is technically defined as more than 25 mL (about two tablespoons) of fluid in the peritoneal cavity, though most patients do not notice symptoms until far more fluid has built up.

An estimated 150,000 paracentesis procedures are performed in the United States each year, according to a 2025 study in Cureus.

How Does Paracentesis Relieve Symptoms?

Paracentesis can relieve uncomfortable symptoms by draining excess fluid from the abdomen. A paracentesis procedure is not a permanent solution but offers patients temporary relief from peritoneal effusion. Peritoneal mesothelioma patients may undergo repeated paracentesis procedures to manage mesothelioma symptoms.

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

What Is the Difference Between Paracentesis and Thoracentesis?

Paracentesis drains excess fluid from the abdomen. Thoracentesis (pleurocentesis) drains excess fluid from the lining around the lung (pleural effusion).

Fluid accumulation is a common symptom for many malignant mesothelioma patients. Paracentesis and thoracentesis are procedures that drain extra fluid.

The key difference between the two is the location from which they drain fluid. Paracentesis drains fluid from the lining of the abdomen. Thoracentesis drains fluid from the lining around the lung.

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What to Expect During a Paracentesis Procedure

Paracentesis is a minimally invasive procedure that is often performed on an outpatient basis. Doctors may repeat the procedure as needed to manage patient symptoms.

The goal of a paracentesis procedure 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 performed for diagnostic or palliative purposes, doctors apply a local anesthetic to numb the insertion site and reduce discomfort 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.

The illustration below shows how fluid is drained from the peritoneal cavity during paracentesis.

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 help prevent low blood pressure following paracentesis.

Generally, 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.

The procedure may be performed by a gastroenterologist, interventional radiologist or other specialist trained in the technique. However, mesothelioma patients may work with a specialized mesothelioma doctor to schedule the paracentesis.

How Paracentesis Relieves Peritoneal Mesothelioma Symptoms

Peritoneal mesothelioma patients can experience swelling of the belly and abdominal discomfort. Draining the excess fluid with paracentesis may reduce these symptoms and improve quality of life.

Ascites may return after paracentesis, and the procedure can be repeated as needed to relieve symptoms.

Patients with recurring ascites may instead be offered a tunneled catheter that allows fluid to be drained at home. 

Paracentesis Risks and Complications

Like all medical procedures, paracentesis may cause complications. Potential side effects include low blood pressure and infection. Research puts major complications, such as serious bleeding or infection, at about 1% – 2% of procedures. Minor issues, most often brief fluid leaking from the needle site, are more common.

The 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 because of 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 generally mild and infrequent.

Patients can discuss potential complications with their oncology teams. Healthcare providers can explain how the risks may affect each patient.

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After a Paracentesis: What to Expect at Home

Most patients go home the same day, once their blood pressure and other vital signs are stable, typically within 1 – 2 hours of the procedure. Doctors generally recommend resting for the first 24 hours and avoiding heavy lifting or strenuous activity until the needle site heals.

A small amount of clear fluid leaking from the needle site for a day or two is normal. Patients should contact their care team right away if they develop a fever, worsening abdominal pain, redness or swelling at the site or continued heavy fluid drainage, since these can signal infection or another complication.

A follow-up appointment is typically scheduled to review any lab results from the drained fluid and check that the needle site is healing properly.

Who Is Eligible for Paracentesis?

In general, patients with abdominal fluid buildup may be eligible for paracentesis. Doctors typically avoid the procedure or take extra precautions in patients with severe clotting problems, a bowel obstruction or an active skin infection at the insertion site. Fluid that has collected in small, separate pockets (loculated fluid) can also make a standard paracentesis difficult, so a doctor may recommend image-guided drainage instead.