Effective treatment of malignant pleural effusion by minimal invasive thoracic surgery: Thoracoscopic talc pleurodesis and pleuroperitoneal shunts in101 patients

Background. For effective palliation of patients with malignant pleural eff usion due to advanced neoplastic disease, any proposed treatment should hav e low procedure-related mortality and morbidity. Methods. The clinical outcome of 119 thoracoscopies in 101 patients (56 wom en, 45 men), from 42 to 91 years of age (mean, 68 +/- 9 years) with maligna nt pleural effusions was evaluated in a retrospective study. Video-assisted thoracoscopy (VATS) talc pleurodesis was done in 105 instances, and a pleu roperitoneal shunt was performed 14 times as an alternative when complete e xpansion of the lung could not be achieved due to tumor implants on the vis ceral pleura. Results. The VATS talc pleurodesis resulted in clinically significant impro vement of dyspnea in 92.2% of the patients. Thirty-day mortality was 2.8% a nd was 2.8%. The mean duration of postoperative survival was 6.7 months. Re current pleural effusion occurred in 5.7% of patients after a mean interval of 6 months. Clinical relief of dyspnea was obtained in 73% of the patient s treated with pleuroperitoneal shunts. Thirty-day mortality in this group was 21% and morbidity was 14.3%. The mean duration of survival was 4.2 mont hs. Conclusions. The VATS talc pleurodesis is appropriate for palliation of pat ients with malignant pleural effusions and should be performed once the dia gnosis has been confirmed. Patients with lungs trapped by visceral carcinom atosis may benefit from placement of a pleuroperitoneal shunt as an alterna tive.