Abstract 9773: Outcomes of Cancer Patients Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion

Abstract

Objectives: We evaluated outcomes of cancer patients undergoing percutaneous pericardiocentesis for pericardial effusion and assessed the procedure’s safety in patients with thrombocytopenia. Background: Pericardial effusion is common in cancer patients. The optimal therapeutic approach is not well defined and in practice depends on patient characteristics and local hospital expertise. Percutaneous pericardiocentesis is less invasive than surgery, but its effectiveness and safety are not well documented. Methods: Cancer patients who underwent percutaneous pericardiocentesis for pericardial effusion between November 2009 and October 2014 at MD Anderson Cancer Center were included. Procedure-related complications, effusion recurrence rate, and overall survival were analyzed. Results: Of 1645 cancer patients referred for pericardial effusion, 212 (13%) underwent percutaneous pericardiocentesis; procedure was successful in 99% of the cases, and there were no procedure-related deaths. Four patients had major procedure-related bleeding necessitating blood transfusions and/or surgical intervention. Procedure-related bleeding did not differ between patients with normal platelet counts and thrombocytopenic patients. Effusion recurred in 26 (12%) patients. Patients with catheter drainage for 3-5 days had the lowest recurrence rate (10%). Median overall survival was 143 days (95% CI, 95-221). Age>65 years, lung cancer, platelet count <20,000/μL, and malignant pericardial fluid were independently associated with poor prognosis. In lung cancer, but not breast cancer, median survival was shorter in patients with malignant effusions than in those with nonmalignant effusions. Conclusion: Percutaneous pericardiocentesis with extended catheter drainage, as primary treatment for pericardial effusion in cancer patients, is safe and effective, including in those with thrombocytopenia. Malignant pericardial effusion significantly shortens the survival outcome of lung cancer patients, but not breast cancer patients.