Effectiveness and prognosis of initial pericardiocentesis in the primary management of malignant pericardial effusion

Abstract

We retrospectively reviewed the records of 100 patients with malignant disease and symptomatic pericardial effusion initially treated with pericardiocentesis at the National Cancer Institute of Mexico between 1985 and 2009. We analyzed predictive factors for recurrence of pericardial effusion by bi- and multivariate analyses. The group comprised 74 women and 26 men. Twenty patients had developed malignant pericardial effusion at the time of primary cancer diagnosis. Recurrence rate after pericardiocentesis was 33%. Progression-free survival for pericardial effusion at one year was 59% (range, 47-71%). Median overall survival (OS) after pericardiocentesis was 40.3+/-7.9 weeks (95% Confidence interval, 24.9-55.7). The sole factor that correlated with increased progression-free survival for pericardial effusion was the presence of bloody pericardial effusion. For OS, multivariate analysis yielded that female gender and presence of pericardial effusion at time of primary malignancy diagnosis were associated with higher life expectancy. Initial pericardiocentesis can provide successful management of patients with a control rate of 67%. In spite of the high effectiveness of the primary management of pericardial effusion with pericardiocentesis in oncologic patients, it might be considered for initial treatment, especially those with poor prognosis, leaving pericardial window as a secondary strategy for recurrence.

Pericardial window operation for malignant pericardial effusion may have worse outcomes for lung cancer than the other cancers

“…2). Our findings were compatible with some prior studies (Celik et al 2012, Cullinane et al 2004, Rousseau-Bussac et al 2014, Tsang et al 2000, Apodaca-Cruz et al 2010). …”

“…Lung cancer has the worst outcomes in patients with MPE (Tsang et al 2000, Celik et al 2012, Cullinane et al 2004, Apodaca-Cruz et al 2010, Rousseau-Bussac et al 2014. Male sex, positive effusion cytology for malignancy, lung cancer, and tamponade or hemodynamic collapse are independently associated with poor survival for MPE (Tsang et al 2000).…”

“…Nevertheless, echo-guided percutaneous pericardial drainage or pericardiocentesis may work with comparable or non-inferior efficacy (Apodaca-Cruz et al 2010, Gumrukcuoglu et al 2011, Patel et al 2013, Tsang et al 2000. Given the unfavorable outcomes of lung cancer in MPE in comparison to the other cancers, should we prefer the percutaneous to surgical approach?…”

Assessment of Outcome of Various Treatment Modalities for Patients with Symptomatic Pericardial Effusion: A Comparative Study

“…Tsang TS et al 14 evaluated the various treatment strategies for primary and secondary management of malignancyrelated pericardial effusions and concluded that for both the primary and secondary management of pericardial effusion in patients with malignancies, echocardiographically guided pericardiocentesis with extended catheter drainage appears to be safe and effective procedure. Apodaca-Cruz A et al 15 retrospectively analyzed patient's records that were affected with malignant disease and symptomatic pericardial effusion initially treated with pericardiocentesis and reported that recurrence rate after pericardiocentesis was 33% and concluded that pericardial window can be considered as a secondary strategy for recurrence, with high effectiveness of the primary management of pericardial effusion with pericardiocentesis in oncologic patients.…”

Systematic review of percutaneous interventions for malignant pericardial effusion

“…This was highlighted by the minimal mortality and morbidity reported in the present systematic review, especially in centres routinely employing echocardiographic guidance (table 3). 19 21 22 Nonetheless, despite its relative safety, isolated pericardiocentesis was associated with a relatively high incidence of 38.3% for recurrent effusions.…”