Pleuroperitoneal shunt for recurrent malignant pleural effusions

Our plain-English summary of Pleuroperitoneal shunt for recurrent malignant pleural effusions, by V. Tsang, H.C. Fernando, P. Goldstraw (Thorax, 1990).

The study

• Authors: V. Tsang, H.C. Fernando, P. Goldstraw
• Journal: Thorax
• Published: 1990;45(5):369-72
• Cited by: 44 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The therapeutic options available for the management of malignant pleural effusions associated with a restricting malignant cortex remain unsatisfactory. The efficacy of pleuroperitoneal shunts was evaluated in 16 patients with recurrent malignant effusions. There were no operative deaths; one patient died on the third postoperative day as a result of lymphangitis carcinomatosa. The median hospital stay was five (range 3-21) days. Palliation was obtained in all but one of the other 15 patients. There was no appreciable reaccumulation of pleural fluid as judged by radiography. Two patients developed occlusion of the shunt. In one case this was due to blood clots in the pleural catheter and necessitated insertion of a new shunt. The other shunt was removed because of obstructing infected fibrin debris, and a rib resection was performed. There were eight deaths related to the underlying malignancy after a mean interval of 7.3 (range 1.5-23) months. The other six patients are still alive, with a mean survival of 11.0 (range 5-20) months, and have achieved good symptomatic relief. The insertion of a pleuroperitoneal shunt can offer effective palliation for patients with recurrent malignant pleural effusions.

In plain English

This report from Brompton Hospital, London, described the authors' use of the Denver pleuroperitoneal shunt, which drains fluid from the chest into the abdomen. Between October 1986 and June 1989, 16 patients with recurrent malignant pleural effusions received the shunt. Eight had mesothelioma, three lung carcinoma and five breast carcinoma. The article did not discuss asbestos exposure. No patient died during surgery, and one died three days afterwards from lymphangitis carcinomatosa. Among the other 15, the median hospital stay was five days, and all but one had good palliation without appreciable fluid reaccumulation on chest radiographs. Two shunts became blocked. Eight patients died of their cancer after a mean of 7.3 months. The text says six others were still alive, although its table lists seven as alive. The longest survivor had mesothelioma, and there was evidence that the shunt had carried mesothelioma cells into the abdomen. The authors concluded that chemical pleurodesis remains the treatment of choice, but that a shunt may be effective palliation when tumour around the lung restricts its expansion. They noted that their assessment of shunt function was essentially clinical.

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 (report of the authors' surgical experience)
• Who was studied: 16 patients aged 42 to 79 (mean 61) with recurrent malignant pleural effusions, treated at the Department of Cardiothoracic Surgery, Brompton Hospital, London, from October 1986 to June 1989. Underlying cancer: mesothelioma in 8, lung carcinoma in 3, breast carcinoma in 5.
• Exposure: No asbestos exposure was studied or reported. The intervention studied was surgical insertion of a Denver pleuroperitoneal shunt.
• Main results:
  • No deaths occurred during the operation. One patient (case 16, breast carcinoma) died on the third postoperative day from lymphangitis carcinomatosa.
  • Among the remaining 15 patients, the median hospital stay was five days (range 3-21).
  • Good palliation was achieved in all but one of the 15 patients. In these patients there was no recurrence of symptoms and no appreciable reaccumulation of pleural fluid on chest radiographs.
  • Two of the 16 patients developed shunt occlusion. In one, blood clots caused the blockage and a new shunt was inserted. In the other, infected fibrin debris caused it and the shunt was removed.
  • Eight patients died of their underlying malignancy after a mean interval of 7.3 months (range 1.5-23).
  • The text reports six other patients still alive, with a mean survival printed as '11 0' months (range 5-20). The PubMed abstract gives this figure as 11.0. The article's table lists seven patients as alive.
  • The longest survivor (case 5, mesothelioma, 23 months) showed clinical and cytological evidence of peritoneal metastases caused by mesothelioma cells carried by the shunt. This patient required abdominal paracentesis for ascites.
• The authors' conclusion: The authors concluded that chemical pleurodesis remains the treatment of choice for malignant pleural effusions. For recurrent cases where tumour around the lung cortex restricts lung expansion, a pleuroperitoneal shunt may be an effective method of palliation.
• Limitations the authors state:
  • Shunt function was assessed essentially clinically, from symptoms and chest radiographs. Breathlessness and radiographic shadows might reflect progression of disease rather than recurrence of the effusion.
  • Doppler ultrasound, used to check shunt function, proved unreliable for detecting flow.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleural Effusion.

Related studies

• The long-term morbidity of pleuroperitoneal shunts in the management of recurrent malignant effusions — O. Genc, M. Petrou, et al. (2000)
• Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients — K. Arapis, R. Caliandro, et al. (2006)
• Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial — S. Muruganandan, M. Azzopardi, et al. (2018)
• Interventional therapies for malignant pleural effusions: the present and the future — R. Thomas, R. Francis, et al. (2014)
• Protocol of the Australasian Malignant Pleural Effusion-2 (AMPLE-2) trial: a multicentre randomised study of aggressive versus symptom-guided drainage via indwelling pleural catheters — M. Azzopardi, R. Thomas, et al. (2016)
• Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis — M. Yeung, E.W. Loh, et al. (2020)

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