VIDEO-ASSISTED THORACOSCOPIC PLEURECTOMY AS THERAPY FOR RECURRING MALIGNANT PLEURAL EFFUSION

Recurring malignant pleural effusion is a common problem with carcinom as invading the pleural surface. Associated symptoms like dyspnoea, co ugh, and arrhythmia considerably limit the patient's remaining quality of life. Numerous methods have been advocated to induce pleurodesis. The various forms of treatment range from chest tube drainage over ins tillations of sclerosing substances like tetracyclines, cytostatics, a nd talc to pleurectomy. None of these treatments, however, so far fulf ills the demands for maximum effectiveness with a low rate of recurren ce and morbidity. With the introduction of video-assisted thoracoscopi c pleurectomy, a method with a low rate of recurrence and morbidity is now at our disposal. During the last 18 months 21 patients with vario us primary tumours have undergone pleurectomy for pleural carcinomatos is in our hospital. All patients had previously been treated by other methods. In all cases of secondary pleural carcinomatosis a complete p arietal pleurectomy was possible. The intra-operative loss of blood wa s low, with an average of 370 ml. Intra- or post-operative complicatio ns did not occur. The mean duration of chest tube drainage was 7 d and the post-operative hospital stay 12 d. During a period of 18 months w e have recorded one recurrence requiring no further treatment. These r esults show that video-assisted thoracoscopic pleurectomy should be un dertaken early when other non-invasive methods have failed.