Video-assisted thoracoscopic pleurectomy as therapy for recurring malignant pleural effusion

Summary

Recurring malignant pleural effusion is a common problem with carcinomas invading the pleural surface. Associated symptoms like dyspnoea, cough, and arrhythmia considerably limit the patient's remaining quality of life. Numerous methods have been advocated to induce pleurodesis. The various forms of treatment range from chest tube drainage over instillations of sclerosing substances like tetracyclines, cytostatics, and talc to pleurectomy. None of these treatments, however, so far fulfills the demands for maximum effectiveness with a low rate of recurrence and morbidity. With the introduction of video-assisted thoracoscopic pleurectomy, a method with a low rate of recurrence and morbidity is now at our disposal. During the last 18 months 21 patients with various primary tumours have undergone pleurectomy for pleural carcinomatosis in our hospital. All patients had previously been treated by other methods. In all cases of secondary pleural carcinomatosis a complete parietal pleurectomy was possible. The intra-operative loss of blood was low, with an average of 370 ml. Intra- or post-operative complications did not occur. The mean duration of chest tube drainage was 7 d and the post-operative hospital stay 12 d. During a period of 18 months we have recorded one recurrence requiring no further treatment. These results show that video-assisted thoracoscopic pleurectomy should be undertaken early when other non-invasive methods have failed.