title: Primary treatment of malignant pleural effusions: video-assisted thoracoscopic surgery poudrage versus tube thoracostomy.
abstract: The objective of this study is to show that primary treatment of malignant pleural effusions secondary to ovarian carcinoma with video-assisted thoracoscopic surgery (VATS)-assisted talc poudrage (VATS-ATP) results in shorter hospital stays and reduced time with a chest tube than primary treatment with a chest tube and chemical pleurodesis. We conducted a retrospective chart review of all patients with a symptomatic pleural effusion secondary to primary ovarian carcinoma receiving intervention from January 1996 to December 2000. Patients either received tube thoracostomy with pleurodesis (n = 22) or VATS-ATP (n = 12). Of the patients treated with tube thoracostomy 18 per cent (4/21) died in the hospital before pleurodesis, 77 per cent (14/19) had successful pleurodesis, and 22 per cent (4/18) failed pleurodesis requiring VATS-ATP. In the group treated primarily with tube thoracostomy the chest tube was in place 8.36 +/- 2.61 days with a hospital stay of 12.64 +/- 5.80 days after the procedure. In the group treated with VATS-ATP there was 100 per cent successful pleurodesis. There were no mortalities. There was one prolonged intubation of 3 days and one incomplete lung reexpansion. The chest tube was in place for 4.58 +/- 1.78 days and a hospital stay of 7.50 +/- 4.12 days postprocedure. Groups treated by tube thoracostomy and VATS were statistically different; P < 0.001 for days with a chest tube and P = 0.011 for hospital days. We conclude that both tube thoracostomy with chemical pleurodesis and VATS-ATP provide adequate treatment of ovarian carcinoma-associated malignant pleural effusions. VATS-ATP provides a shorter duration of chest tube placement and postprocedure hospital stay.
authors.affiliation: Department of Surgery, School of Medicine, University of South Carolina, Columbia, South Carolina 29203, USA.
authors.forename: Kurt V
authors.initials: KV
authors.lastname: Erickson
authors.forename: Michael
authors.initials: M
authors.lastname: Yost
authors.forename: Raymond
authors.initials: R
authors.lastname: Bynoe
authors.forename: Carl
authors.initials: C
authors.lastname: Almond
authors.forename: James
authors.initials: J
authors.lastname: Nottingham
mesh_terms: D000368:Aged; D000465:Algorithms; D015505:Chest Tubes; D005260:Female; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology; D016066:Pleural Effusion, Malignant / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D018700:Pleurodesis; D012189:Retrospective Studies; D013627:Talc / Q000627:therapeutic use; D020775:Thoracic Surgery, Video-Assisted; D013907:Thoracostomy; D016896:Treatment Outcome
chemical_list: D013627:Talc