PURPOSE: Pericardial effusions are common and potentially life-threatening occurrences in cancer patients. The optimal management is unclear. The purpose of this study was to evaluate the outcomes of percutaneous drainage (PD) versus subxiphoid pericardial window (SPW) in the treatment of pericardial effusions in a cancer population.
METHODS: Retrospective review of consecutive procedures for the treatment of pericardial effusions at a tertiary cancer hospital from 2002-2009. Demographic, surgical, pathologic, and echocardiographic data were evaluated for the endpoints of survival, the need for repeat intervention, and adverse events.
RESULTS: 237 patients were treated for pericardial effusions during the study period, with 189 SPWs and 48 PDs performed. Primary malignancies included lung (109, 46%), breast (46, 19%), heme (24, 10%), GI (16, 7%), and other (42, 18%). Of the 210 patients who underwent echocardiography, a similar proportion of patients demonstrated evidence of tamponade on echocardiogram (30/45, 67% in PD vs. 101/165, 61% in SPW, p=0.603). Re-intervention (repeat drainage or re-operation) for recurrent effusions occurred more frequently in patients undergoing PD vs. SPW (9, 18.7% vs. 7, 3.7%; p=0.0011). Pericardial sclerosis was performed after drainage in 152 patients (64%), but was not associated with a reduction in the rate of re-intervention (sclerosed: 12/152, 8% vs. not sclerosed: 4/85, 5%; p=0.427). Median survival was similarly poor in both groups (PD, 4.7 months vs. SPW, 5.8 months). Major technical complications (including hemorrhage, ventricular puncture, and pneumothorax) were infrequent in both groups (2, 1% in SPW vs. 1, 2% in PD; p=0.12).
CONCLUSIONS: Both SPW and PD were effective treatments for pericardial effusions in cancer patients, but SPW was associated with a significantly lower need for re-intervention, without greater morbidity or mortality.
CLINICAL IMPLICATIONS: Although considered more invasive, SPW may offer a more durable treatment option without increased risk in this population with limited life expectancy.
DISCLOSURE: The following authors have nothing to disclose: Matthew Bott, Patrick Wagner, Robert Spang, Elizabeth Stillwell, Eileen McAleer, Valerie Rusch, Wendy Schaffer, James Huang
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