PURPOSE: To describe a series of patients who underwent sequential bilateral definitive procedures to manage bilateral MPE during the course of their cancer.
METHODS: A retrospective chart review was conducted on all patients referred to a single academic university hospital for the definitive management of MPE's from 1995 to 2007.
RESULTS: A total 232 patients referred for the management of symptomatic MPE's; 41% had Breast CA and 20% had Lung Ca. Twenty-four (10%) of these patients developed significant bilateral MPE's requiring bilateral procedures. In these patients, the average age at the diagnosis of the first MPE was 53 + 10 yrs, and 22 of the 24 (92%) patients were female. 16 patients had breast adenocarcinoma (67%) as the underlying cause of the MPE's; 2 patients had ovarian ca, 2 had adenocarcinoma of unknown origin, 2 had peritoneal ca, 1 had lymphoma, and 1 had colon ca. In contrast, no patients undergoing bilateral interventions had underlying lung cancer. There were 49 total procedures performed. 22 pleural catheters placed and 27 MVATS-P were performed. One patient had a catheter originally placed but, due to failure to pleurodese, subsequently underwent a MVATS-P on the same side. The average number of days from the diagnosis to the intervention of the first MPE was 125 days, whereas, the average number of days from the diagnosis to the intervention of the second MPE was 81 days. 100% of the patients that underwent bilateral management for MPE's successfully tolerated the procedures, suffered no perioperative complications, and were discharged home.
CONCLUSION: Therapeutic interventions for symptomatic bilateral MPE's represent a minority population when compared to the total number of interventions for MPE's at this center. Lung cancer patients may not survive long enough, nor have the functional status at the time of presentation with bilateral MPE to benefit from palliative definitive interventions.
CLINICAL IMPLICATIONS: For those who develop symptomatic bilateral MPE's and have a reasonable functional status, bilateral management appears to be a safe and effective option for palliation.
DISCLOSURE: Koonj Shah, No Financial Disclosure Information; No Product/Research Disclosure Information