Video-assisted thoracoscopic pleurectomy in the management of malignant pleural effusion.

STUDY

OBJECTIVE

To evaluate the outcome of pleurectomy using video-assisted thoracic surgery (VATS) for pleurodesis in patients with malignant pleural effusion.

DESIGN

Cohort prospective study. Follow-up of patients from referral for thoracoscopy to death.

SETTING

Regional Cardiothoracic Surgical Centre.

PATIENTS: Nineteen patients (median age 63 years, range 51 to 84 years) with malignant pleural effusion, secondary to mesothelioma in 13 and metastatic adenocarcinoma in 6.

INTERVENTION: Video-assisted parietal pleurectomy.

MEASUREMENTS AND

RESULTS

Median operating time was 35 min (range 15 to 60 min). The median fall in hemoglobin concentration in the first 24 h postsurgery was 1.1 g/dL (0.3-2.5 g/dL). The median postoperative morphine requirement was 1.25 mg/h (0-6.2 mg/h) in the first 12 h postoperatively. All patients were successfully extubated in the operating room, without the need for reventilation, and all patients were successfully discharged from the hospital with a median postoperative stay of 5 days (range 2 to 20 days). At current median follow-up of 12 months (range 4 to 17 mon) 6 patients died of their underlying disease. In the remaining 13 patients, two have developed recurrent effusions.

CONCLUSIONS

Using VATS to perform parietal pleurectomy is a safe, effective method of obtaining palliative pleurodesis in patients with malignant effusions.