Thoracoscopic collagen pleurodesis in the treatment of malignant pleural effusions.
OBJECTIVE
Pleurodesis is of a potential benefit in pleural carcinomatosis and symptomatic malignant effusions, but the best way of achieving this is still uncertain. The aim of this prospective study was to analyse the results of pleurodesis after intra-pleural thoracoscopic administration of collagen powder.


METHODS
45 patients (19 men and 26 women; median age of 64 years, range from 36 to 73 years) with malignant pleural effusions underwent thoracoscopic collagen pleurodesis. The procedure involved thoracoscopic drainage of pleural effusion and intra-pleural insufflation of 1 g of bovine dermal collagen powder under general anaesthesia. Assessment of the immediate side effects and pH estimation of drained pleural fluid took place whilst inpatient. The patients were subsequently followed up for 1 year at 3-monthly intervals including outpatient clinical review and chest radiography. Prognostic value of pleural fluid pH in relation to the outcome of pleurodesis and patients' survival was statistically analysed.


RESULTS
The procedure was well tolerated and there were no serious complications or deaths. Thoracoscopic collagen pleurodesis resulted in immediate resolution of malignant pleural effusion and all patients remained free of re-accumulated fluid for at least 1 month. Only 5 (11%) patients later developed recurrent effusion and required its repeat drainage at some point during the follow-up period. In the vast majority (89%) patients, thoracoscopic collagen pleurodesis proved successful in complete and permanent resolution of pleural fluid collection. Acid medium (pH < 7.3) of plural fluid was associated with poor survival (P < 0.05), but did not influence the clinical and radiological outcome of collagen pleurodesis (P > 0.05).


CONCLUSIONS
Thoracoscopic collagen pleurodesis is a simple and effective method of treatment of malignant pleural effusions.
Akopov
Andrei L
AL
Research Institute of Pulmonology, Pavlov Medical University, Saint-Petersburg 197089, Russia. akopovand@mail.ru
Egorov
Vladimir I
VI
Varlamov
Vladimir V
VV
Levashev
Yuri N
YN
Artioukh
Dmitri Y
DY
D000328:Adult; D000368:Aged; D003094:Collagen / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D018700:Pleurodesis / Q000009:adverse effects / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome
D003094:Collagen