Long-term indwelling pleural catheter (PleurX) for malignant pleural effusion unsuitable for talc pleurodesis
Wednesday, July 23rd, 2008.
European Journal of Surgical Oncology. 2008 Jul 19. [Epub ahead of print] [Link]
Sioris T, Sihvo E, Salo J, Räsänen J, Knuuttila A.
Heart Center, Tampere University Hospital, P.O. Box 2000, FIN-33521 Tampere, Finland.
Abstract
Aims: Talc pleurodesis using talc slurry via chest tube is a primary option in malignant pleural effusion, since life expectancy is short and surgical decortication is hazardous. Incomplete lung expansion after fluid evacuation, and/or excessive fluid secretion predicts failure of pleurodesis. A mini-invasive alternative was investigated.
Methods: Between March 2004 and September 2005, 51 consecutive patients with malignant pleural effusion, and clinically considered unsuitable for talc pleurodesis, received an indwelling pleural catheter (Denver PleurX). In 47, implantation was done bedside using local anaesthesia. There were 24 men and 27 women, median age 63 (range 36–85) years, receiving 39 right side, 10 left side, and 2 bilateral catheters. There were 19 non-small cell lung cancer cases, 7 mesothelioma, and 25 with other malignancy. Chemotherapy was being given to 18 patients and was not interrupted.
Results: Discharge to home was possible in 71% (36 of 71 patients) on the following day. At 2 years follow-up in September 2007, one patient was alive. Mean survival was 3 months (range 5 days to 37+ months) for all patients, with best median survivals of 5.5–6 months in breast and ovarian cancer. Catheter was removed or replaced in 15% (8 of 51 patients) due to infection, air leak, or blockage. One patient requested decortication for excessive fluid secretion. None required surgery or died due to catheter-related complications. Pleural fusion with subsequent catheter removal was achieved in 21% (11 of 51 patients).
Conclusions: An indwelling pleural catheter is a safe alternative for patients with malignant pleural effusion unsuitable for talc pleurodesis. In some, pleural fusion may be achieved.
Keywords: Malignant pleural effusion; PleurX; Indwelling; Implantable; Catheter
Glossary
- oncology
- (on-call-o-jee) the branch of medicine concerned with the diagnosis and treatment of cancer.
- chemotherapy
- (key-mo-THER-uh-pee) treatment with drugs to destroy cancer cells. Chemotherapy is often used with surgery or radiation to treat cancer when the cancer has spread, when it has come back (recurred), or when there is a strong chance that it could recur.
- cell
- the basic unit of which all living things are made. Cells replace themselves by splitting and forming new cells (mitosis). The processes that control the formation of new cells and the death of old cells are disrupted in cancer.
- catheter
- (cath-eh-tur) a thin, flexible tube through which fluids enter or leave the body.
- cancer
- malignancy; a group of diseases typified by abnormal, generally out-of-control, cell growth.
- bilateral
- (bi-lat-er-ul) on both sides of the body; for example, bilateral breast cancer is cancer in both breasts.
- mesothelioma
- a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.
- pleural effusion
- an abnormal accumulation of fluid, usually caused by trauma or disease, in the pleural space.
