Download PDF
Thorac Cardiovasc Surg 2009; 57(1): 42-46
DOI: 10.1055/s-2008-1039109
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

Recurrent Pleural Effusion: Who Benefits from a Tunneled Pleural Catheter?

T. Schneider1 , P. Reimer1 , K. Storz1 , M. Klopp1 , J. Pfannschmidt1 , H. Dienemann1 , H. Hoffmann1
  • 1Department of Thoracic Surgery, Thoraxklinik University of Heidelberg, Heidelberg, Germany
Further Information

Publication History

received July 23, 2008

Publication Date:
23 January 2009 (online)

    Permissions and Reprints All articles of this category

Abstract

Recurrent malignant pleural effusion (MPE) is a common concomitant phenomenon of malignant disease, which can worsen the patient's quality of life and lead to significant morbidity. Tunneled indwelling pleural catheters (TIPC) offer new modalities in patients with recurrent MPE and impaired dilatability of the lung. We report on our experience with 100 consecutive patients suffering from recurrent benign (n = 12) and malignant pleural effusion (n = 88) who were treated with TIPC. The catheter was placed during a VATS procedure or under local anesthesia in an open technique. The median residence time of the TIPC was 70 days; spontaneous pleurodesis was achieved in 29 patients. The rate of complications was low: pleura empyema (n = 4), accidental dislodgement (n = 2), malfunction of the drainage (n = 3). In conclusion, TIPC is a useful method for the palliative treatment of patients with recurrent malignant or nonmalignant pleural effusions and 3 groups of patients seem to benefit most: a) patients with the intraoperative finding of a trapped lung in diagnostic VATS procedure; b) patients after a history of repeated pleuracenteses or previously failed attempts at pleurodesis; c) patients in a reduced condition with a limited lifespan due to underlying disease.

Key words

tunneled pleural catheter - malignant pleural effusion - entrapped lung - pleurodesis - pleuracentesis

References

  • 1 Sugiura S, Ando Y, Minami H, Ando M, Sakai S, Shimokata K. Prognostic value of pleural effusion in patients with non-small cell lung cancer.  Clin Cancer Res. 1997;  3 47-50
    PubMedSearch in Google Scholar
  • 2 Aelony Y. Dry talc pleurodesis via chest tube.  Chest. 2003;  123 308
    CrossrefPubMedSearch in Google Scholar
  • 3 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
  • 4 Antonangelo L, Vargas F S, Teixeira L R, Acencio M M, Vaz M A, Filho M T, Marchi E. Pleurodesis induced by talc or silver nitrate: evaluation of collagen and elastic fibers in pleural remodeling.  Lung. 2006;  184 105-111
    CrossrefPubMedSearch in Google Scholar
  • 5 Robinson L A, Fleming W H, Galbraith T A. Intrapleural doxycycline control of malignant pleural effusions.  Ann Thorac Surg. 1993;  55 1115-1122
    CrossrefPubMedSearch in Google Scholar
  • 6 Ruckdeschel J C, Moores D, Lee J Y, Einhorn L H, Mandelbaum I, Koeller J, Weiss G R, Losada M, Keller J H. Intrapleural therapy for malignant pleural effusions. A randomized comparison of bleomycin and tetracycline.  Chest. 1991;  100 1528-1535
    CrossrefPubMedSearch in Google Scholar
  • 7 Dresler C M, Olak J, Herndon 2nd J E. Phase III intergroup study of talc poudrage vs. talc slurry sclerosis for malignant pleural effusion.  Chest. 2005;  127 909-915
    CrossrefPubMedSearch in Google Scholar
  • 8 Tan C, Sedrakyan A, Browne J, Swift S, Treasure T. The evidence on the effectiveness of management for malignant pleural effusion: a systematic review.  Eur J Cardiothorac Surg. 2006;  29 829-838
    CrossrefPubMedSearch in Google Scholar
  • 9 Froudarakis M E, Klimathianaki M, Pougounias M. Systemic inflammatory reaction after thoracoscopic talc poudrage.  Chest. 2006;  129 356-361
    CrossrefPubMedSearch in Google Scholar
  • 10 Maskell N A, Lee Y C, Gleeson F V, Hedley E L, Pengelly G, Davies R J. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size.  Am J Respir Crit Care Med. 2004;  170 377-382
    CrossrefPubMedSearch in Google Scholar
  • 11 Janssen J P. Is thoracoscopic talc pleurodesis really safe?.  Monaldi Arch Chest Dis. 2004;  61 35-38
    PubMedSearch in Google Scholar
  • 12 Pien G W, Gant M J, Washam C L, Sterman D H. Use of an implantable pleural catheter for trapped lung syndrome in patients with malignant pleural effusion.  Chest. 2001;  119 1641-1646
    CrossrefPubMedSearch in Google Scholar
  • 13 Putnam Jr J B, Walsh G L, Swisher S G, Roth J A, Suell D M, Vaporciyan A A, Smythe W R, Merriman K W, DeFord L L. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter.  Ann Thorac Surg. 2000;  69 369-375
    PubMedSearch in Google Scholar
  • 14 Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion.  Chest. 2006;  129 362-368
    CrossrefPubMedSearch in Google Scholar
  • 15 van den Toorn L M, Schaap E, Surmont V F, Pouw E M, van der Rijt K C, van Klaveren R J. Management of recurrent malignant pleural effusions with a chronic indwelling pleural catheter.  Lung Cancer. 2005;  50 123-127
    CrossrefPubMedSearch in Google Scholar
  • 16 Musani A I, Haas A R, Seijo L, Wilby M, Sterman D H. Outpatient management of malignant pleural effusions with small-bore, tunneled pleural catheters.  Respiration. 2004;  71 559-566
    CrossrefPubMedSearch in Google Scholar
  • 17 Pollak J S, Burdge C M, Rosenblatt M, Houston J P, Hwu W J, Murren J. Treatment of malignant pleural effusions with tunneled long-term drainage catheters.  J Vasc Interv Radiol. 2001;  12 201-208
    CrossrefPubMedSearch in Google Scholar
  • 18 Warren W H, Kalimi R, Khodadadian L M, Kim A W. Management of malignant pleural effusions using the pleur(x) catheter.  Ann Thorac Surg. 2008;  85 1049-1055
    CrossrefPubMedSearch in Google Scholar
  • 19 Tremblay A, Mason C, Michaud G. Use of tunnelled catheters for malignant pleural effusions in patients fit for pleurodesis.  Eur Respir J. 2007;  30 759-762
    CrossrefPubMedSearch in Google Scholar
  • 20 Janes S M, Rahman N M, Davies R J, Lee Y C. Catheter-tract metastases associated with chronic indwelling pleural catheters.  Chest. 2007;  131 1232-1234
    CrossrefPubMedSearch in Google Scholar

Dr. Thomas Schneider

Department of Thoracic Surgery
Thoraxklinik University of Heidelberg

Amalienstraße 5

69126 Heidelberg

Germany

Phone: + 49 6 22 13 96 81 07

Fax: + 49 6 22 13 96 11 02

Email: thomas.schneider@thoraxklinik-heidelberg.de