Pericardial effusions represent a terminal stage in patients with malignant disease. A VATS pericardial window (PW) can palliate symptoms. Longevity of the procedure may depend on pericardial fluid cytology.
Retrospective review of 66 VATS PW for malignant pericardial effusion (MPE); males/female ratio 36/30, mean age 54.8 ± 14.3 (ranging from 19 to 79). Kaplan-Meyer survival curve and Log-Rank List were used to analyze the data.
Mean hospital stay was 8.7 ± 5.5 days. Overall median survival was 5.4 months: 43% at 1 yr, 17.6% at 3 yrs, 10% 5 yrs. There was no difference in survival between patients younger than 65 compared to older patients. There was no difference in survival between genders. Mean survival in cytology negative patients (n=32) was 12 ± 0.9 months, compared to 4.7 ± 0.09 months in cytology positive patients (n=34, Log-Rank, p=0.0416). The 5-year survival in cytology negative patients was 19%. Positive cytology predicted death within 36 months. There was no correlation between length of hospital stay and survival. The one year survival in lung and esophageal cancer patients was 32.7% and for all other cancers 44.8%, and the 2 year survival was 19.8% and 28.9% respectively(p = NS).Seven patients (8.2%) required repeat PW . Recurrence occurred in 4 cases after anterior PW only, in 2 cases after posterior PW only, and in 1 case after combined anterior and posterior PW.
Pericardiotomy is an effective palliative intervention that avoids repeated invasive procedures in 90% of cases. Positive cytology of the pericardial effusion is predictive of short survival. Survival in this series is better than literature benchmarks.
Both an anterior and posterior PW should be placed to avoid recurrence. Fluid cytology should be obtained during PW for prognostic purposes.
Pathology of Malignant Pericardial Effusionn=NSCLC&SCLC32Breast Cancer8Esophageal Neoplasm5Non-Hodgkin-Lymphoma5Leukemia3Other Tumors and Metastatic Disease*13*
(Thymoma 1, malig melanoma 1, chodrosarcoma 1, angiosarcoma 1, osteosarcoma 1, spindle cell neoplasm 1, rhabdomyosarcoma 1, nerve sheath tumor 1, mesothelioma 1, colon ca 1, ovarien ca 1, testicular ca 1, UKO)
Siyamek Neragi-Miandoab, None.