title: VATS pericardiotomy for patients with known malignancy and pericardial effusion: survival and prognosis of positive cytology and metastatic involvement of the pericardium: a case control study.
abstract: BACKGROUND
  Pericardiotomy for cancer patients with effusion can alleviate symptoms, but with unclear effect on long term survival. Our experience with VATS technique has produced some long-term survivors.
  
  
  METHODS
  A retrospective review of 62 VATS pericardiotomy for pericardial effusion in patients with known malignancy. Kaplan-Meier survival curves and Log-Rank tests were used for analysis.
  
  
  RESULTS
  The mean age was 54.8+/-14.3 years (ranging from 19 to 79). The mean hospital stay was 8.7+/-5.5 days. The median survival was 6.75 months (range 1 month-10 years). Overall one-year survival was 44.2%, 3-year survival 17.6%, and 5-year survival 10% after drainage of pericardial effusion. The mean survival in cytology negative patients (n=21) was 13.4+/-0.98 months, compared to 4.89+/-0.9 months in cytology positive patients (n=27) (p=0.0175). The 5-year survival in cytology negative patients was 19.6%, while none of the patients with positive cytology were alive after 36 months. The mean survival in patients with no evidence of metastatic disease on the pericardium (n=28) was 12.8+/-0.9 months, compared to patients with metastatic disease of the pericardium (n=22) 4.66+/-0.8 months (p=0.026).
  
  
  CONCLUSIONS
  VATS Pericardiotomy can provide effective long-term drainage in patients with symptomatic pericardial effusion. Positive cytology and metastatic involvement of the pericardium are predictive of worse survival. Survival greater than 5 years can be expected in 19% and 17% of patients with negative fluid cytology and negative metastatic disease of the pericardium, respectively.
authors.affiliation: Department of Surgery, Cardiothoracic Surgery, Boston University Medical Center, Boston, MA 02118, USA. sneragi@yahoo.com
authors.forename: Siyamek
authors.initials: S
authors.lastname: Neragi-Miandoab
authors.forename: Philip A
authors.initials: PA
authors.lastname: Linden
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Ducko
authors.forename: Raphael
authors.initials: R
authors.lastname: Bueno
authors.forename: William G
authors.initials: WG
authors.lastname: Richards
authors.forename: David J
authors.initials: DJ
authors.lastname: Sugarbaker
authors.forename: Michael T
authors.initials: MT
authors.lastname: Jaklitsch
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality*; D010490:Pericardial Effusion / Q000209:etiology / Q000601:surgery*; D010492:Pericardiectomy / Q000379:methods*; D010496:Pericardium / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted