Minimally invasive thoracic surgery for diagnostic assessment and palliative treatment in recurrent neoplastic pleural effusion.
BACKGROUND
We evaluated the effectiveness of VATS in the diagnosis and palliative treatment of recurrent neoplastic pleural effusions.


METHODS
From 1987 to 2001, we performed 325 VATS chemical pleurodesis for malignant pleural effusions. We used talc in 253 subjects (78 %) and alcohol in 72 (22 %) as the sclerosant agent. In 226 patients (68 %) we performed biopsies because the histology was unknown.


RESULTS
Mean operating time was 33.38 +/- 9.77 minutes (median: 32; range: 19 - 58), and the mean duration of chest intubation was 3.78 +/- 1.33 days (median: 4; range 2 - 8). Complications occurred in 2 % of patients. Thirty-day mortality was 2 %. Mean postoperative in hospital stay was 5.53 +/- 1.90 days (median 6; range: 2 - 11). We obtained 264 (81 %) therapeutic successes (no effusion recurrence within 4 months), and 55 relapses of which 32 had talc insufflation (13 % of talc group) and 23 alcohol instillation (32 % of alcohol group).


CONCLUSIONS
VATS chemical pleurodesis is a safe, useful, versatile procedure for oncological pleural effusion management. The use of talc rather than alcohol significantly increased the therapeutic success rate. VATS should be considered the treatment of choice in patients with advanced neoplasm to obtain good palliation and a better quality of life.
Oncologic Thoracic Surgery, National Cancer Institute, Milan, Italy. ppbm@virgilio.it
P P
PP
Brega-Massone
B
B
Conti
B
B
Magnani
F
F
Ferro
C
C
Lequaglie
D000328:Adult; D000368:Aged; D000438:Alcohols / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy*; D010166:Palliative Care; D016066:Pleural Effusion, Malignant / Q000175:diagnosis / Q000628:therapy*; D018700:Pleurodesis / Q000379:methods*; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage; D013627:Talc / Q000008:administration & dosage; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome
D000438:Alcohols; D012597:Sclerosing Solutions; D013627:Talc