82 - Drain for life? Outcomes of Percutaneous Drainage of Malignancy-Associated Abscesses

Purpose: Anecdotal experience suggests drainage of malignancy-associated abscesses has worse outcomes compared to those associated with benign disease, with the possibility of requiring a drain for the remainder of a patient’s life. This study describes the outcomes of malignancy-associated abscess drainage.

Materials and Methods: 27 patients (13 M:14F; mean age 54 ± 14 years) who underwent malignancy-associated abscess drainage between 2020-2023 were identified from a QA database. Data regarding demographics, cancer history, initial and subsequent drain related procedures, complications, and outcomes were analyzed.

Results: Cancer diagnoses included colon (n=14, 52%), gynecologic (n=4, 15%), hepatobiliary (n=2, 7%), and others (n=7, 6%). Most common abscess locations were intraperitoneal (n=9, 33%) and hepatic (n=6, 22%). 15 abscesses (56%) were associated with a primary tumor and 12 (44%) with metastatic tumors. Mean abscess size was 8.1 ± 3.2 cm. 13 (48%) were intratumoral, 11 (41%) immediately adjacent to tumor, and 3 (11%) at a site of treated tumor with viable disease. 4 patients (15%) had drains placed as a bridge to surgical resection of the associated malignancy. 9 patients (33%) had abscess resolution after drainage: 6 primarily resolved and 3 required secondary intervention (abscess recurrence with resolution after repeat drainage). 10 patients (37%) died with their drain and 2 (7%) are alive with a chronic drain. See table for details of these groups. In addition, one patient’s tube fell out and was not replaced per patient request and another patient had their tube removed for comfort prior to hospice. Of 119 total tube changes performed, 31 (26%) were for leakage/clogging, 16 (13%) for malposition/displacement, and 8 (7%) for pain at tube site. Bowel fistula was documented in 8 patients. 3 patients developed drain-related bleeding complications, of which one required arterial stent-graft placement.

Conclusion: Drainage of malignancy-associated abscess may result in a drain for the remainder of life in >40% of patients. In select patients, drainage may be a successful temporizing measure awaiting tumor resection. This study helps inform the discussion surrounding malignancy-associated drain placement.