Palliative treatment of malignant pleural effusions

Our plain-English summary of Palliative treatment of malignant pleural effusions, by D. Horn, D. Dequanter, P. Lothaire (Acta Chirurgica Belgica, 2010).

The study

• Authors: D. Horn, D. Dequanter, P. Lothaire
• Journal: Acta Chirurgica Belgica
• Published: 2010;110(1):32-4
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim: The aim of the current study was to analyse the results of video assisted thoracoscopic (VATS) talc pleurodesis for malignant pleural effusion.

Material And Methods: From January 2002 to December 2004, 50 VATS procedures were performed under general anaesthesia on 48 patients for malignant pleural effusion. There were 45 women and 3 men with a median age of 57 years. The most common primary neoplasms were breast cancer (68%), ovarian cancer (6%), colon cancer (4%) and lung cancer (4%). Five patients had other types of tumour, including malignant lymphoma, fibrosarcoma, renal cell carcinoma, malignant pleural mesothelioma, acute myeloblastic leukaemia.

Results: The average duration of the operation was 46 min (range 20-120). Median duration of postoperative drainage was 5 days (range 2-13) and postoperative hospitalisation was 8 days (range 2-13). Four patients had postoperative complications. Thirty-day mortality was 1/48. One patient died from myocardial infarction. Three postoperative complications were noted (one non-septic febrile episode, one bilateral pneumopathy and one transitory hypoxaemia, treated by non invasive ventilation). Patients were relieved from dyspnoea in 34/48 of the cases (71%). Median survival was 6 months (ranging from 14 days to 2 years).

Conclusions: Early talc pleurodesis via VATS is a safe technique for successfully treating pleural effusion and preventing recurrence in palliative patients with a symptomatic malignant pleural effusion.

In plain English

This article described one Belgian hospital surgery department's results with a keyhole chest operation, video-assisted thoracoscopic (VATS) talc pleurodesis, used to treat fluid build-up around the lungs caused by cancer. From January 2002 to December 2004, 50 operations were performed on 48 patients (45 women and three men, median age 57 years). Breast cancer was the most common underlying cancer (68%). Malignant pleural mesothelioma was one of the other tumour types listed. The article did not study asbestos exposure. One of 48 patients (2%) died within 30 days, from a myocardial infarction (heart attack), and the complication rate was 6%. The lung did not fully re-expand in 9 of 50 cases (18%). Breathlessness improved in a clinically significant way in 71% of patients. The fluid came back in 17 cases after a median of 9 months, and median survival was 6 months. The authors concluded that talc pleurodesis via VATS is effective and safe, and that early use is needed to treat the effusion and prevent recurrence.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series: an analysis of results from VATS talc pleurodesis operations performed at one surgical department
• Who was studied: 48 patients with malignant pleural effusion (45 women, three men, median age 57 years) who had 50 operations from January 2002 to December 2004, Department of Surgery, CHU Charleroi, Montigny le Tilleul, Belgium. Primary cancers were mostly breast (68%), ovarian (6%), colon (4%) and lung (4%). Five patients had other tumours, including malignant pleural mesothelioma.
• Exposure: No asbestos exposure was studied. The intervention was VATS talc pleurodesis with 4 g of sterile purified talc blown into the chest through a talc atomizer.
• Main results:
  • Primary cancers among the patients were breast cancer (68%), ovarian cancer (6%), colon cancer (4%) and lung cancer (4%). The other tumour types included malignant pleural mesothelioma.
  • Median drainage time after surgery was 5 days (range 2 to 13). Median hospital stay was 8 days (range 2 to 13).
  • The lung did not fully re-expand in 9 of 50 cases (18%).
  • Thirty-day mortality was 1 of 48 patients (2%), a death from myocardial infarction. The morbidity (complication) rate was 6%.
  • Breathlessness (dyspnoea) improved in a clinically significant way in 71% of patients. Dyspnoea of grade I remained in 6 of 48 patients (12.5%), grade II in 6 of 48 (12.5%) and grade IV in 2 of 48 (4%).
  • A recurrent effusion was diagnosed in 17 cases after a median time of 9 months.
  • Median survival was 6 months (range 14 days to 2 years).
• The authors' conclusion: The authors concluded that talc pleurodesis via VATS is an effective and safe procedure with a high first-attempt success rate and long-term control of malignant pleural effusion. They also concluded that early use is needed to treat the effusion and prevent recurrence.

Topics

Medical terms in this study, explained in our Lexicon: Palliative Care, Pleural Effusion, Video-Assisted Thoracoscopic Surgery (VATS), Talc Pleurodesis, Neoplasm, Ovarian Cancer, Colorectal Cancer, Lung Cancer.

Related studies

• Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients — K. Arapis, R. Caliandro, et al. (2006)
• The long-term morbidity of pleuroperitoneal shunts in the management of recurrent malignant effusions — O. Genc, M. Petrou, et al. (2000)
• Mesothelioma--VATS biopsy and lung mobilization improves diagnosis and palliation — M.W. Grossebner, A.A. Arifi, et al. (1999)
• Is pleurectomy and decortication superior to palliative care in the treatment of malignant pleural mesothelioma? — I. Zahid, S. Sharif, et al. (2011)
• Nonselective transarterial chemoperfusion: a palliative treatment for malignant pleural mesothelioma — T.J. Vogl, S. Lindemayr, et al. (2013)
• Surgical and non-surgical management of malignant pleural effusions — D.B. Fitzgerald, C.F.N. Koegelenberg, et al. (2018)

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