Download PDF
Thorac Cardiovasc Surg 2004; 52(4): 191-195
DOI: 10.1055/s-2004-820869
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

Minimally Invasive Thoracic Surgery for Diagnostic Assessment and Palliative Treatment in Recurrent Neoplastic Pleural Effusion[*]

P. P. Brega-Massone1 , B. Conti1 , B. Magnani2 , F. Ferro3 , C. Lequaglie1
  • 1Oncologic Thoracic Surgery, National Cancer Institute, Milan, Italy
  • 2Statistical Unit, II. AA. RR., Pavia, Italy
  • 3General Surgery, Civil Hospital, Voghera, Italy
Further Information

Publication History

Received February 27, 2003

Publication Date:
04 August 2004 (online)

    Permissions and Reprints All articles of this category

Abstract

Background: We evaluated the effectiveness of VATS in the diagnosis and palliative treatment of recurrent neoplastic pleural effusions. Methods: From 1987 to 2001, we performed 325 VATS chemical pleurodesis for malignant pleural effusions. We used talc in 253 subjects (78 %) and alcohol in 72 (22 %) as the sclerosant agent. In 226 patients (68 %) we performed biopsies because the histology was unknown. Results: Mean operating time was 33.38 ± 9.77 minutes (median: 32; range: 19 - 58), and the mean duration of chest intubation was 3.78 ± 1.33 days (median: 4; range 2 - 8). Complications occurred in 2 % of patients. Thirty-day mortality was 2 %. Mean postoperative inhospital stay was 5.53 ± 1.90 days (median 6; range: 2 - 11). We obtained 264 (81 %) therapeutic successes (no effusion recurrence within 4 months), and 55 relapses of which 32 had talc insufflation (13 % of talc group) and 23 alcohol instillation (32 % of alcohol group). Conclusions: VATS chemical pleurodesis is a safe, useful, versatile procedure for oncological pleural effusion management. The use of talc rather than alcohol significantly increased the therapeutic success rate. VATS should be considered the treatment of choice in patients with advanced neoplasm to obtain good palliation and a better quality of life.

Key words

Neoplastic pleural effusion - diagnostic assessment - palliative treatment - pleurodesis - video-assisted thoracoscopic surgery (VATS)

1 The abstract was selected and presented at the EACTS/ESTS Joint Meeting 2001. Lisbon (Portugal), September 16 - 19, 2001

References

  • 1 Glazer M, Borkman N, Lafair J S, Kramer M R. Successful talc slurry pleurodesis in patients with nonmalignant pleural effusion.  Chest. 2000;  117 1404-1409
    CrossrefPubMedSearch in Google Scholar
  • 2 Antony W B, Loddenkemper R, Astoul P. et al . Management of malignant pleural effusions.  Eur Respir J. 2001;  18 402-419
    CrossrefPubMedSearch in Google Scholar
  • 3 Waller D A, Morritt G N, Forty J. Video-assisted thoracoscopic pleurectomy in the management of malignant pleural effusion.  Chest. 1995;  107 1454-1456
    PubMedSearch in Google Scholar
  • 4 Ross R T, Burnett C M. Talc pleurodesis: a new technique.  Am Surg. 2001;  67 467-468
    PubMedSearch in Google Scholar
  • 5 Cardillo G, Facciolo F, Carbone L. et al . Long-term follow-up of video-assisted talc pleurodesis in malignant recurrent pleural effusions.  Eur J Cardio-Thorac Surg. 2002;  21 302-305
    CrossrefPubMedSearch in Google Scholar
  • 6 Yim A PC, Chan A TC, Lee T W, Wan I YP, Ho J KS. Thoracoscopic talc insufflation versus talc slurry for symptomatic malignant pleural effusions.  Ann Thorac Surg. 1996;  62 1655-1658
    CrossrefPubMedSearch in Google Scholar
  • 7 Macha H N, Reichle G, von Zwehl D, Kemmer H P, Bas R, Morgan J A. The role of ultrasound assisted thoracoscopy in the diagnosis of pleural disease.  Eur J Cardio-Thorac Surg. 1993;  7 19-22
    CrossrefPubMedSearch in Google Scholar
  • 8 De Campos J R, Vargas F S, De Campos Werebe E. et al . Thoracoscopy talc poudrage: a 15-year experience.  Chest. 2001;  119 801-806
    CrossrefPubMedSearch in Google Scholar
  • 9 Brega Massone P P, Conti B, Magnani B, Lequaglie C, Cataldo I. Video-assisted thoracoscopic surgery for diagnosis, staging and management of lung cancer with suspected mediastinal lymphadenopathy.  Surg Laparosc Endosc Percutan Tech. 2002;  12 104-109
    CrossrefPubMedSearch in Google Scholar
  • 10 Viallat J R, Rey F, Astoul P, Boutin C. Thoracoscopic talc poudrage pleurodesis for malignant effusions. A review of 360 cases.  Chest. 1996;  110 1387-1393
    CrossrefPubMedSearch in Google Scholar
  • 11 Menzies R, Charbonneau M. Thoracoscopy for the diagnosis of pleural disease.  Ann Intern Med. 1991;  114 271-276
    PubMedSearch in Google Scholar
  • 12 Petrakis I, Katsamouris A, Drossitis I, Chalkiadakis G. Video-assisted thoracoscopic surgery in the diagnosis and treatment of chest diseases.  Surg Laparosc Endosc Percutan Tech. 2002;  12 104-109
    CrossrefPubMedSearch in Google Scholar
  • 13 Petrou M, Kaplan D, Goldstraw P. Management of recurrent malignant pleural effusions. The complementary role of talc pleurodesis and pleuroperitoneal shunt.  Cancer. 1995;  75 801-805
    CrossrefPubMedSearch in Google Scholar
  • 14 Mager H J, Maesen B, Verzijlbergen F, Schramel F. Distribution of talc suspension during treatment of malignant pleural effusion with talc pleurodesis.  Lung Cancer. 2002;  36 77-81
    CrossrefPubMedSearch in Google Scholar
  • 15 Schulze M, Boehle A S, Kurdow R, Dohrmann P, Henne-Bruns D. Effective treatment of malignant pleural effusion by minimal invasive thoracic surgery: thoracoscopic talc pleurodesis and pleuroperitoneal shunt in 101 patients.  Ann Thorac Surg. 2001;  71 1809-1812
    CrossrefPubMedSearch in Google Scholar
  • 16 Genc O, Petrou M, Ladas G, Goldstraw P. The long-term morbidity of pleuroperitoneal shunt in the management of recurrent malignant pleural effusion.  Eur J Cardio Thorac Surg. 2000;  18 143-146
    CrossrefPubMedSearch in Google Scholar
  • 17 Parekh K, Rusch V, Bains M, Downey R, Ginsberg R. VATS port site recurrence: a technique dependent problem.  Ann Surg Oncol. 2001;  8 175-178
    CrossrefPubMedSearch in Google Scholar
  • 18 Mutsaerts E L, Zoetmulder F A, Rutgers E J. Port site metastasis as a complication of thoracoscopic metastasectomy.  Eur J Surg Oncol. 2001;  27 327-328
    CrossrefPubMedSearch in Google Scholar
  • 19 Diacon A H, Wyser C, Bolliger C T. et al . Prospective randomized comparison of thoracoscopic talc poudrage under local anesthesia versus bleomycin instillation for pleurodesis in malignant pleural effusions.  Am J Respir Crit Care Med. 2000;  162 1445-1449
    PubMedSearch in Google Scholar
  • 20 Allen M SA, Deschamps C, Jones D M, Trastek V F, Paroleiro P C. Video-assisted thoracic surgical procedures: the Mayo experience.  Mayo Clin Proc. 1996;  71 351-359
    PubMedSearch in Google Scholar
  • 21 Ghio A J, Roggli V, Light R W. Talc should not be used for pleurodesis in patients with nonmalignant pleural effusions.  Am J Respir Crit Care Med. 2001;  164 1741
    PubMedSearch in Google Scholar
  • 22 Ong K C, Indumathi V, Raughuram J, Ong V Y. A comparative study of pleurodesis using talc slurry and bleomycin in the management of malignant pleural effusions.  Respirology. 2000;  5 99-103
    CrossrefPubMedSearch in Google Scholar
  • 23 Brant A, Eaton T. Serious complications with talc slurry.  Respirology. 2001;  6 181-185
    CrossrefPubMedSearch in Google Scholar
  • 24 Light R W. Management of pleural effusions.  J Formos Med Assoc. 2000;  99 523-531
    PubMedSearch in Google Scholar
  • 25 Shoji T, Tanaka F, Yanagihara K, Inui K, Wada H. Phase II study of repeated intrapleural chemotherapy using implantable access system for management of malignant pleural effusion.  Chest. 2002;  121 821-824
    CrossrefPubMedSearch in Google Scholar

1 The abstract was selected and presented at the EACTS/ESTS Joint Meeting 2001. Lisbon (Portugal), September 16 - 19, 2001

Dr. P. P. Brega-Massone

Oncologic Thoracic Surgery · National Cancer Institute Milan

Via Cascina Spelta, 24/b

27100 Pavia

Italy

Phone: + 39(02)23902384

Fax: + 39 (02) 2 36 04 86

Email: ppbm@virgilio.it