Lung cancer and ipsilateral pleural effusion.
Lung cancer presenting with ipsilateral pleural effusion is considered to have a poor prognosis. Thoracoscopy has been invoked as a useful tool for staging those cases before proceeding to thoracotomy, especially in patients with large pleural effusions. In cases where there is only a small effusion or no effusion at all, direct thoracotomy would be the choice, with pleural lavage during the operation and immediate cytology investigation. We performed thoracoscopy in 76 patients with lung cancer and ipsilateral pleural effusion (55 cytologically positive and the remaining negative), and we found only five cases with potentially resectable tumor. They were submitted to thoracotomy and resection could be accomplished in none of them, due to direct mediastinal tumor invasion. On the other hand, we found visceral pleura involvement without effusion in 31 out of 167 patients submitted to thoracotomy for lung cancer in our Institution. The tumor could be resected in all but one of these cases. Talc pleurodesis was performed in all patients who were found to have pleural effusion and non-resectable tumor at thoracoscopy, and we obtained a 68% success rate in cases with no trapped lung, as opposed to 56% in patients with trapped lung (massively covered by fibrin and/or tumor). Pleural fluid glucose and pH are good predictors of the outcome of pleurodesis.
Rodriguez Panadero
F
F
Servicio de Neumología, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
D003581:Cytodiagnosis; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D009367:Neoplasm Staging; D016066:Pleural Effusion, Malignant / Q000209:etiology*; D010997:Pleural Neoplasms / Q000175:diagnosis / Q000628:therapy; D013906:Thoracoscopy