Postoperative outcome after palliative treatment of malignant pleural effusion

Abstract

Background The objective of this nationwide, registry‐based study was to compare the two most frequently used procedures for the palliative treatment of a malignant pleural effusion (MPE) and to evaluate differentiated indications for these two procedures. Methods This was a retrospective observational study based on data of the “PLEURATUMOR” registry of the German Society for Thoracic Surgery. Patients who were documented in the period from January 2015 to November 2021 and had video‐assisted thoracic surgery (VATS) talc pleurodesis or implantation of an indwelling pleural catheter (IPC) were included. Results A total of 543 patients were evaluated. The majority suffered from secondary pleural carcinomatosis (n = 402; 74%). VATS talc pleurodesis (n = 361; 66.5%) was performed about twice as often as IPC implantation (n = 182; 33.5%). The duration of surgery was significantly shorter in IPC‐patients with 30 min compared to VATS talc pleurodesis (38 min; p = 0.000). Postoperative complication rate was 11.8% overall and slightly higher after VATS talc pleurodesis (n = 49; 13.6%) than after IPC implantation (n = 15; 8.2%). After VATS talc pleurodesis patients were hospitalized significantly longer compared to the IPC group (6 vs. 3.5 days; p = 0.000). There was no significant difference in postoperative wound infections between the groups (p = 0.10). The 30‐day mortality was 7.9% (n = 41). Conclusion The implantation of an IPC can significantly shorten the duration of surgery and the hospital stay. For this reason, the procedure should be matched with the patient's expectations preoperatively and the use of an IPC should be considered not only in the case of a trapped lung.

Comparison of outcomes of surgical and other invasive treatment modalities for malignant pleural effusion in patients with pleural carcinomatosis

“…However, serious complications were uncommon ( 2 ). Reflecting the findings of several other studies, including those by Markowiak et al ( 19 ) and Dilkaute et al ( 20 ), IPC placement drastically reduced the LOS for patients compared to the other more invasive treatment options. The mean duration of hospital stay in our IPC group at initial admission was six days.…”

“…This study started from the day of initial admission and hospitalization, in contrast to the time of intervention, which is often used as a starting point in other research articles. This is one reason for the longer total time spans, as opposed to generally shorter time intervals, as seen in the similar articles mentioned above ( 19 ). The longer LOS, apart from IPC placement, was also due to our surgical procedure because we routinely apply a level of suction of 20 cmH 2 O for at least 72 hours after talc pleurodesis.…”

Uniportal Video-assisted Thoracoscopic Talc Pleurodesis in the Treatment of Malignant Pleural Effusions. Is Early Phase Talc Pleurodesis More Effective?

“…12,18 Low-performance status and delay between pleural effusion diagnosis and pleurodesis were reported to be statistically significant factors for postoperative mortality. 14,18 Markowiak et al 19 suggested that 30-day mortality (5.8%) was not related to the procedure but to the primary disease.…”

“…In the literature, the success rate in patients who underwent VATS talc pleurodesis for MPE was between 76% and 96%. 19,20 Cardillo et al 14 argued that the early-phase VATS talc pleurodesis procedure increased the chance of success. Meanwhile, Cobanoglu et al 5 suggested that talc pleurodesis is more likely to be successful when MPE is asymptomatic and a low amount of effusion is detected.…”

In Vitro Assessment of Cisplatin/Hyaluronan Complex for Loco-Regional Chemotherapy

“…For example, surgery and loco-regional chemotherapy are combined in PM management such that, after tumor resection, the pleural cavity is perfused with a cisplatin solution to remove residual malignant cells. However, the procedure per se represents a hazard for the medical team in the operating room, since the solution can leak during the perfusion of thoracic cavity, leading to possible contamination of surfaces and exposure of the surgical team to the antineoplastic drug [7]. Additionally, cisPt as a liquid solution is easily cleared from the application site, thus rapidly decreasing its local effect and exposing other parts of the body to the drug.…”