PURPOSE: Medical thoracoscopy with talc pleurodesis has been accepted as an effective method for palliation of recurrent malignant pleural effusions. High tumor burden detected during thoracoscopy is likely to decrease effectiveness of talc pleurodesis and may predispose to an entrapped lung. We sought to determine whether placement of indwelling pleural catheters would prevent this.
METHODS: Between January 2007 and April 2011, 78 patients with symptomatic malignant pleural effusions underwent medical thoracoscopy at the University of Florida. All these patients had experienced relief and re-expansion of lung after therapeutic thoracentesis. Depending on thoracoscopic appearance of the pleura, the decision to perform talc poudrage, PleurX catheter (Cardinal Health) placement, or both, was made. PleurX catheter was used for palliation in patients with probable entrapped lung or in patients with concern for potential unsuccessful pleurodesis.
RESULTS: Extensive tumor studding and adhesion were noted in 18/78 patients and they underwent PleurX catheter placement under thoracoscopic visualization. Diagnoses included lung adenocarcinoma (n=9), colorectal cancer (n=2), breast cancer (n=3), small cell lung cancer (n=1), renal cell carcinoma (n=1), mesothelioma (n=1) and squamous cell carcinoma of uncertain origin (n=1). Nineteen PleurX catheters were placed; thirteen were right-sided, four were left-sided, and one bilaterally. Talc insufflation was performed prior to catheter placement in 11/18 patients. No complications were noted. Subsequently, pleurodesis was achieved in 7/19 cases and catheters were removed.
CONCLUSIONS: PleurX catheters may be successfully placed at the time of thoracoscopy in patients with high tumor burden and adhesions. Symptoms were controlled in all patients without complications. Some patients were ultimately freed of PleurX catheter.
CLINICAL IMPLICATIONS: 1) Malignant pleural effusions portend poor survival and symptom relief is the primary goal in management. 2) Extensive pleural involvement visible during thoracoscopy may preclude adequate pleurodesis with talc poudrage. Placement of a PleurX catheter at the same time would enable not only drainage but also an alternative method for effective palliation.
DISCLOSURE: The following authors have nothing to disclose: Abbie Begnaud, Ragheed Alturkmani, Michael Jantz
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