S5478 When Relief Becomes Risk: Long-Term Complications of a Tunneled Peritoneal Catheter in a Patient With Metastatic NET

Introduction: Tunneled intraperitoneal catheters (TIPCs) are widely used for symptom relief in malignant ascites, especially in end-of-life care. However, their role in neuroendocrine tumors (NETs), where patients often live longer, is unclear. Localized NETs have a 5-year survival rate nearing 97%, while median survival post-catheter placement for ascites is about 7 weeks. We present a case illustrating complications from long-term catheter use in a NET patient. Case Description/Methods: A 62-year-old woman with metastatic NET, diagnosed in 2008, was treated with monthly octreotide and Y-90 radioembolization. In 2024, she developed recurrent ascites, refractory to medical management and not eligible for further procedural intervention. After multiple large-volume paracentesis, she opted for tunneled catheter placement to manage symptoms at home. Initially, she noted improvement in discomfort and dyspnea. Weeks later, she developed catheter-site leakage and pain, requiring readmission and catheter exchange. Over months, she had recurring admissions for abdominal pain and suspected infections. Ultimately, she was admitted to the intensive care unit (ICU) with sepsis and encephalopathy. The catheter was removed following shared decision-making. Discussion: TIPCs are well-studied in gastroenterology and gynecologic cancers but lack data in processes like NETs. Prolonged survival in NETs increases the risk of delayed complications. In this case, early relief was followed by infections, readmissions, and ICU care, outcomes counter to typical expectations of reduced hospital use. Major studies include fewer than 10% NET patients, with no stratified outcomes. This highlights a gap in evidence and calls for tailored approaches. Catheter placement should not be static but reassessed over time. In patients who exceed standard palliative timelines, options like intermittent paracentesis or early removal may better balance safety and symptom control. NET-specific guidelines and reassessment protocols are needed. While TIPCs can be beneficial in malignant ascites, they may not suit all cancer types. In NETs, longer survival demands closer follow-up and individualized care. This case underscores the need for research and careful decision-making in using TIPCs for this unique population.