To determine if an indwelling pleural catheter is safe and effective in the management of malignant pleural effusions (MPE) secondary to malignant mesothelioma.
Retrospective analysis of an indwelling pleural catheter database in a single center.
Twenty six catheter insertions (PleurxTM, Denver Biomedical, Denver CO) were attempted in 21 patients / 23 effusions (12 left, 11 right). Patients had proven (19) or strongly suspected (2) malignant mesothelioma and symptomatic MPE. Mean age was 69.5 years and all but one patient were male. Five patients required a second catheter: 3 for inadequate drainage of the initial drain and 2 for contralateral effusions. All patients were followed until catheter removal or death. Symptom control (dyspnea) was found to be excellent, partial or absent in 13 (57%), 9 (39%) and 1(4%) of the 23 effusions treated respectively. Eleven of the 23 (48%) effusions treated achieved spontaneous pleurodesis (mean 75 days, range 14-189 days). Complications included need for 2nd catheter for inadequate drainage/loculation (2), tumour seeding (2), failed insertion secondary to loculations (1), empyema (1), cellulitis (1), BP fistula (1), and bleeding (1). Overall median survival was 29 weeks (95% C.I. 25-54 weeks). Patients achieving spontaneous pleurodesis survived longer than those who did not (71 vs. 25 weeks, p=0.01 log rank). These results compare favorably with our experience with pleural catheters in MPE secondary to other malignancies.
Indwelling pleural catheters can offer palliation of dyspnea secondary to MPE associated with mesothelioma on an outpatient basis with acceptable complication rates.
Symptomatic MPE secondary to mesothelioma can be treated successfully with an indwelling pleural catheter.
A. Tremblay, None.