MANAGEMENT OF RECURRENT MALIGNANT PLEURAL EFFUSIONS - THE COMPLEMENTARY ROLE OF TALC PLEURODESIS AND PLEUROPERITONEAL SHUNTING

Background. Recurrent pleural effusions in patients with advanced canc er is a common problem that causes significant morbidity and can negat ively affect patients' quality of life for their remaining months. Sev eral palliative treatment options are available. Methods. The results of a 10-year experience with 180 patients referred for the surgical pa lliation of their condition were retrospectively reviewed. Their mean age was 60 years (range, 20-90 years). One hundred and thirty-four pat ients (74%) had been treated before referral with one or more of the f ollowing modalities: repeated needle thoracocentesis (87 patients), tu be thoracostomy (24 patients), chemical or biologic pleurodesis (22 pa tients), and pleurectomy (1 patient). One hundred and seventeen patien ts demonstrated full lung expansion at thoracoscopy/mini-thoracotomy a nd underwent talc pleurodesis, whereas the other 63 patients had the ' 'trapped lung syndrome'' and required the insertion of a pleuroperiton eal shunt (Denver, Biomedical, Inc). Results. There were no intraopera tive deaths and the early death rate was 5.9% for the talc pleurodesis group and 3.2% for the group that received shunts. The mean hospital stay for the patients receiving talc and shunts was 7.3 days (range, 3 -15 days) and 5.9 days (range, 2-12 days), respectively. Follow-up dat a were available in 60% of the patients and showed that effective pall iation was achieved in more than 95% of patients in each group. There were eight patients (12%) with blocked shunts (five requiring replacem ent or renovation and three requiring removal and open drainage) at 1 week to 4 months after insertion. Two patients (one from each group) r equired one further episode of treatment by thoracocentesis. The media n survival for the talc and shunt groups was 4.9 months (range, 1-36 m onths) and 5.4 months (range, 1-53 months). Patients with effusions be cause of secondary breast carcinoma or lymphomas survived the longest. Conclusion. In patients with malignant pleural effusions in whom pleu rodesis is precluded by limited lung expansion, effective palliation c an be achieved by pleuroperitoneal shunt insertion.