Senior Deputy Director European Institute of Oncology Milan, Lombardia, Italy
Disclosure(s):
Domenico Galetta, MD, PhD: No relevant disclosure to display
Purpose: Malignant pleural effusion (MPE) is a very disabling condition that often affects patients with advanced neoplasm and presents a challenge for treatment. The aim of this study is to report our 20-year experience evaluating the short and long-term outcomes of thoracoscopic management of MPE. Methods: From 1998 to 2022, 1634 patients underwent videothoracoscopy (VATS) for pleural effusion. Of these 1519 (93%) were treated for a MPE. There were 604 men (39.8%) and 915 women (60.2%), with a median age of 64 years (range, 17-92 years). In all patients VATS was performed under general anaesthesia. The pleural effusion was carefully aspirated; fibrinous adhesions were taken down while dense fibrous adhesions were selectively divided. Multiple pleural biopsies were always performed. Pleurodesis was performed with 8 g of sterile purified talc. One or two 28 Ch chest tubes was left in situ for a median of 4 days (range, 3-5 days). We analyzed the risk factors, efficiency, outcome, follow-up, and survival, while taking into consideration primary disease and general condition. Results: ATS was performed on the right side in 883 cases (58.1%), on the left in 609 (40.1%), and bilateral in 27 (1.8%). Operative mortality was nil. Postoperative complications occurred in 37 cases (2.4%) including 9 major (0.6%) and 28 minor (1.8%) complications. 30-day mortality was 0.7% (12/1519). Specific histologic diagnosis was obtained in all patients including lung cancer in 593 (39%), breast cancer in 493 (32.4%), mesothelioma in 186 (12.2%), gynecological cancers in 46 (3.0%), kidney cancer 20 (1.3%), and others tumors in 181 (11.9%). Follow-up was available for 1492 patients (98.2%). After a median follow-up of 67 months (range 4-107 months), talc pleurodesis was successful in controlling recurrence of effusion in 1467 patients (96.7%) and improvement of symptoms in 1423 patients (93.7%). The success rate did not show any statistically significant difference between patients who underwent postoperative adjuvant therapy and patients who did not. In 11 cases (0.7%) with failure of talc pleurodesis a redo-VATS was performed. Risk factors for death within 30 days included a Karnofsky index of less than 50%, a body mass index of less than 25 kg/m2, and male gender. The survival rate was negatively influenced by a preoperative Karnofsky index of less than 60%. Conclusion: Patients with pleural effusion due to malignant disease gain from early pleurodesis. VATS represents the method of choice for both diagnosis and treatment of MPE. The most favorable outcome after talc pleurodesis was seen in women whose lungs were fully expandable, in patients whose Karnofsky index exceeded 60%, and in patients whose body mass index was greater than 25 kg/m2.
Identify the source of the funding for this research project: none
