Recurrent Pleural Effusion: Who Benefits from a Tunneled Pleural Catheter?

Abstract

Recurrent malignant pleural effusion (MPE) is a common concomitant phenomenon of malignant disease, which can worsen the patient's quality of life and lead to significant morbidity. Tunneled indwelling pleural catheters (TIPC) offer new modalities in patients with recurrent MPE and impaired dilatability of the lung. We report on our experience with 100 consecutive patients suffering from recurrent benign (n = 12) and malignant pleural effusion (n = 88) who were treated with TIPC. The catheter was placed during a VATS procedure or under local anesthesia in an open technique. The median residence time of the TIPC was 70 days; spontaneous pleurodesis was achieved in 29 patients. The rate of complications was low: pleura empyema (n = 4), accidental dislodgement (n = 2), malfunction of the drainage (n = 3). In conclusion, TIPC is a useful method for the palliative treatment of patients with recurrent malignant or nonmalignant pleural effusions and 3 groups of patients seem to benefit most: a) patients with the intraoperative finding of a trapped lung in diagnostic VATS procedure; b) patients after a history of repeated pleuracenteses or previously failed attempts at pleurodesis; c) patients in a reduced condition with a limited lifespan due to underlying disease.

The Use of a PleurX Catheter in the Management of Recurrent Benign Pleural Effusion: A Concise Review

“…Schneider et al [5] reported a complication rate of 9% in the total 100 patients with malignant and benign effusions treated with PleurX catheter. In this study, the authors did not specify whether the complications occurred in patients with benign or malignant effusions.…”

“…A recurrent effusion is usually defined as repetitive fluid accumulation despite optimal medical management of the underlying condition. Those effusions are usually treated with multiple therapeutic thoracenteses prior to considering other options [5,6].…”

“…Schneider et al [5] recently studied groups of patients with recurrent malignant and benign PE for whom prior interventions failed or who were high risk for more invasive procedures. Fourteen PleurX catheters were placed in 12 patients with benign effusions secondary to liver cirrhosis or chronic exudative pleurisy.…”

Managing malignant pleural effusion with an indwelling pleural catheter: factors associated with spontaneous pleurodesis

“…Trapped lung unsurprisingly led to a higher chance of persistent output. Nonetheless, it has been observed that patients with IPC inserted for trapped lung can still achieve SP, 12,15,17,18,20 or their lung expansion will improve after IPC. 17 In our cohort, two patients had their trapped lung reexpanded after IPC insertion; one of whom had IPC removed successfully without re-accumulation of effusion.…”

“…The pooled rate of SP in MPE patients has been reported to be 45.6%, 11 achieved after a mean duration of 26 to 56 days after IPC insertion. [11][12][13][14][15][16][17][18][19][20] The possibility of SP is attractive as there is a chance that an IPC will no longer be required. The aims of this study were to review our single-centre experience of the safety of IPC in the management of symptomatic MPE and to explore the potential clinical factors associated with SP.…”