PARIETAL PLEURECTOMY FOR MALIGNANT PLEURAL EFFUSION

Background: Malignant pleural effusions are seen frequently in clinica l practice and are most commonly caused by breast cancer and lung canc er, Standard treatment usually consists of complete drainage of the pl eural space via a chest tube and instillation of a pleural irritant to obtain pleural symphysis. In a majority of instances, such treatment effectively controls the pleural space; however, standard treatment fa ils in some cases. Methods: Twenty-four patients who did not respond t o standard treatment for malignant pleural effusion were subjects for parietal pleurectomy, which was usually performed through an axillary thoracotomy. In several cases, decortication was also necessary. The s tudy population was composed of 18 women and six men. Twelve of the pa tients had carcinoma of the breast, five carcinoma of the lung, and fo ur carcinoma of the ovary. Results: Three patients died in the periope rative period to give an operative mortality of 12.5%. The other 21 pa tients all had satisfactory control of their recurrent malignant effus ions. Their survival time ranged from 2 to 30 months (average 10.6). C onclusions: Parietal pleurectomy is an effective operation for recurre nt malignant pleural effusion. However, because of its significant mor bidity and mortality, it should be reserved for failures of standard t reatment, and patient selection is important.