The long-term morbidity of pleuroperitoneal shunts in the management of recurrent malignant effusions

Our plain-English summary of The long-term morbidity of pleuroperitoneal shunts in the management of recurrent malignant effusions, by O. Genc, M. Petrou, G. Ladas, et al (European Journal of Cardio-thoracic Surgery, 2000).

The study

• Authors: O. Genc, M. Petrou, G. Ladas, P. Goldstraw
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2000;18(2):143-6
• Cited by: 70 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Over the last 15 years we have managed patients with malignant pleural effusion, using a single procedure with thoracoscopy and talc pleurodesis or shunt as appropriate. Talc pleurodesis remains our primary treatment option but in those patient shown to have the 'trapped lung syndrome', in whom pleurodesis would fail, we have been using a pleuroperitoneal shunt.

Methods: This retrospective review was undertaken to evaluate the mortality and morbidity of pleuroperitoneal shunts in the management of malignant pleural effusions and to assess their long-term results. Three hundred and sixty patients were treated for malignant effusions during the period 1983-1998, 160 (44.4%) of whom had a pleuroperitoneal shunt inserted. There were no intraoperative deaths and the hospital mortality was three patients (1.87%). Follow up was available for 88.1% of patients. The median survival of all malignant cases was 7.7 months (range 1-72 months). Mesothelioma patients survived somewhat longer with a median survival of 10.1 months.

Results: Shunt complication occurred in 21 patients (14.8%). Twelve patients developed shunt occlusion, requiring revision in five and replacement in seven. The shunt was removed in eight patients due to skin erosion in one patient and infection in seven patients. The distal limb of shunt was broken in one patient and the shunt was replaced. One patient developed malignant seeding along the chest wall at the site of shunt insertion but there were no incidences of peritoneal deposits. Effective palliation was achieved in 95% of patients.

Conclusions: Pleuroperitoneal shunt insertion provides effective and safe palliation for malignant pleural effusion when associated with the 'trapped lung syndrome'. There are however complications which require revision or shunt removal. There is no evidence that peritoneal deposits result from pleuroperitoneal shunting.

In plain English

This was a retrospective review of patients treated for recurrent malignant pleural effusion, a buildup of fluid around the lung caused by cancer. They were treated at the Royal Brompton and Middlesex Hospitals in London between January 1983 and December 1998. Of 360 patients, 160 had a 'trapped lung', in which a thickened layer encasing the lung kept it from re-expanding. Instead of talc pleurodesis, these patients received a pleuroperitoneal shunt, a device that drains chest fluid into the abdomen. The report covered only this shunt group, which included patients with mesothelioma. Three patients died in hospital (1.87%). Follow-up was available for 141 of the 160. Median survival was 7.7 months for evaluated patients and 10.1 months for mesothelioma patients. Shunt complications occurred in 21 patients (14.8%), including blockage in 12 and removal in eight, mostly for infection. One patient with metastatic breast cancer developed tumour seeding along the shunt line. There were no cases of peritoneal deposits. The authors reported effective palliation in approximately 95% of patients. They concluded that the shunt can provide effective palliation when trapped lung makes pleurodesis unsuitable.

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: retrospective review of a surgical case series (pleuroperitoneal shunt group only)
• Who was studied: 160 patients with recurrent malignant pleural effusion and trapped lung who received a pleuroperitoneal shunt (89 male, 71 female, mean age 59.26 years), out of 360 patients referred to the Royal Brompton Hospital and Middlesex Hospital, London, January 1983 to December 1998; Table 1 lists 36 mesothelioma patients in the shunt group
• Exposure: not an asbestos exposure study; the intervention studied was insertion of an internal pleuroperitoneal shunt (Denver Biomedical) in patients whose lung was encased by a restrictive cortex (trapped lung syndrome)
• Main results:
  • No intraoperative deaths; three early deaths from progressive respiratory failure, a hospital mortality rate of 1.87% in the shunt group
  • Mean hospital stay was 6.2 days
  • Follow-up data were available for 141 of 160 shunt patients (88.1%)
  • Median survival of evaluated shunt patients was 7.7 months (range 2 weeks to 72 months)
  • Mesothelioma patients in the shunt group had a median survival of 10.1 months
  • Shunt complications occurred in 21 patients (14.8%)
  • Shunt occlusion occurred in 12 patients (8.5%) a mean of 2.7 months after insertion; five shunts were revised and seven replaced, with effective palliation after the second procedure in all
  • The shunt was removed in eight patients (5.6%): seven for infection (4.37%) and one for skin erosion
  • In one further patient the distal limb of the shunt fractured and the shunt was replaced
  • One patient with metastatic breast cancer developed malignant seeding along the shunt line seven months after insertion; no cases of peritoneal deposits occurred
  • All but seven patients (4.9%) obtained good palliation, so effective palliation was achieved in approximately 95%
• The authors' conclusion: The authors concluded that pleuroperitoneal shunt insertion can provide effective palliation for recurrent symptomatic malignant effusion where trapped lung makes pleurodesis unsuitable, while noting complications that require revision or removal
• Limitations the authors state:
  • The authors state that follow-up information was not provided for patients referred by oncologists abroad

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Thoracoscopy, Talc Pleurodesis, Trapped Lung, Pleurodesis, Median Overall Survival, Mesothelioma.

Related studies

• Pleuroperitoneal shunt for recurrent malignant pleural effusions — V. Tsang, H.C. Fernando, et al. (1990)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Palliative treatment of malignant pleural effusions — D. Horn, D. Dequanter, et al. (2010)
• Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy — E. Nizri, D. Baratti, et al. (2018)
• Surgical and non-surgical management of malignant pleural effusions — D.B. Fitzgerald, C.F.N. Koegelenberg, et al. (2018)
• Video-assisted management of malignant pleural effusion in breast carcinoma — R. Gasparri, F. Leo, et al. (2006)

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