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 be associated with the possibility of an entrapped lung. An alternative is placement of indwelling pleural catheters to achieve the same desired effect.
Between January 2007 and April 2009, 43 patients with significant symptoms due to malignant pleural effusions underwent medical thoracoscopy at the University of Florida for pleurodesis. All these patients had undergone therapeutic thoracentesis initially and experienced symptomatic relief with expansion of the underlying lung. Depending on the appearance of the pleural surfaces at the time of thoracoscopy, a decision to perform either talc poudrage with or without PleurX catheter (Cardinal Health) placement or PleurX catheter placement alone was made. The PleurX catheter was used for palliation in patients with probable entrapped lung or in patients with concern for potential unsuccessful pleurodesis.
Extensive tumor studding and adhesion were noted in 7/43 patients and they underwent PleurX catheter placement under thoracoscopic visualization. Diagnoses included adenocarcinoma of the lung (n = 5), metastatic colon cancer (n = 1), and mesothelioma (n = 1). Right sided effusions were present in 4 patients, 2 had left effusions, and one patient had bilateral effusions and PleurX catheters were placed in each site (n = 8). Talc insufflation was performed prior to catheter placement in 4/7 patients. No complications were noted in any patient during the procedure.
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.
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 and placement of a PleurX catheter at the same time would enable not only drainage but also an alternative method for effective palliation.
Varsha Kulkarni, No Financial Disclosure Information; No Product/Research Disclosure Information