Video-Thoracoscopic Surgical Pleurodesis in the Management of Malignant Pleural Effusion: The Importance of an Early Intervention

Abstract

Thoracentesis plays an important role in cancer patients with symptomatic effusions, although its effect is short-lived and symptoms recur in almost all patients. Early video-thoracoscopic surgical pleurodesis may provide added benefit to a group of patients with advanced cancer presenting with symptomatic malignant pleural effusion. Seventy-six patients with advanced cancer and pleural effusion due to pulmonary-pleural metastases were recruited. In 51 cases (67.1%), at least one thoracentesis was performed before admission for surgery. Preoperative staging consisted of chest radiograph, CT scan, and blood gas analysis. The mean Karnofsky performance status was about 50. Pleurodesis with talc poudrage was completely successful in all patients, with a morbidity rate of 2.6%. There was no post-operative mortality. Three patients (3.9%) underwent further thoracenteses for recurrence of pleural effusion within two months after the procedure. Early use of talc insufflated by video-thoracoscopic surgery is an effective and relatively safe method for treating pleural effusion, and preventing recurrence, in advanced cancer patients.

Efficacy of pleurodesis for malignant pleural effusions in breast cancer patients

“…Talc has been reported as safe and efficacious for pleurodesis [15][16][17][18][19][20][21][22][23]. A Cochrane review reported that pleurodesis with talc provided the highest relative chance of MPE nonrecurrence when compared with bleomycin, tetracycline, mustine or chest-tube drainage alone [24].…”

Palliative Treatment of Malignant Pleural Effusions

“…In these late treated cases, partial decortication had no effect on the re-expansion of the trapped lung. In their study, MARRAZZO et al (13) showed that early thoracocentesis plays an important role in cancer patients with symptomatic effusions. In their study, pleurodesis with talc poudrage was completely successful in all patients with a morbidity rate of 2.6%.…”

“…In our study, postoperative pleural drainage was used until fluid output was less than 100 ml/24 h. For some authors (13,21), the chest tube could be removed within 24 hours.…”

Clinical-therapeutic management of thoracoscopy in pleural effusion: a groundbreaking technique in the twenty-first century

“…Another argument that strengthens the use of thoracoscopy in a PE clinically classifi ed as malignant or nonaffi liated is that approximately 60% of these patients need a pleurodesis during their evolution [15] and it should be done as soon as possible because a "trapped lung" invalidates the process [16]. Thoracoscopy not only provides a reliable diagnosis [17] but allows a therapeutic intervention to be performed that will have an effect only in early stages of the condition [18].…”