title: Palliation and pleurodesis in malignant pleural effusion: the role for tunneled pleural catheters.
abstract: BACKGROUND
  Despite increasing use of tunneled pleural catheters (TPCs), their efficacy as a definitive procedure for achieving palliation or spontaneous pleurodesis (SP) in the management of malignant pleural effusion (MPE) remains unclear. In the largest TPC series to date, we evaluate the efficacy for palliation and review the rate and predictors of SP.
  
  
  METHODS
  Retrospective review of 418 TPCs (355 patients) over 2 years (September 2007-September 2009) was performed. Palliation was deemed successful when the patient did not require any other subsequent effusion-directed drainage procedure. SP was defined as satisfying the following criteria: (a) TPC removal without need for further effusion-directed intervention during the patient's lifespan and (b) no evidence of effusion reaccumulation by clinical and radiographic evidence at 1-month postremoval follow-up.
  
  
  RESULTS
  After TPC placement, no subsequent effusion-directed procedure was required for 380 of 418 (91%). SP was achieved after only 26% of TPCs (110 of 418), in which the median time to catheter removal was 44 days. Neither demographics nor primary tumor type predicted SP. In patients selected for TPC placement in the operating room, SP occurred in 36% (39 of 107), with 45% in loculated MPE (13 of 29, p = 0.014). Complications occurred after 20 TPCs (4.8%), with none occurring after bedside placement.
  
  
  CONCLUSIONS
  TPC placement is safe and provides durable palliation, most often obviating the need for subsequent procedures in MPE patients. TPC, however, remains suboptimal at achieving pleurodesis.
authors.affiliation: Division of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center,1275 York Avenue, New York, NY 10065, USA.
authors.forename: Kei
authors.initials: K
authors.lastname: Suzuki
authors.forename: Elliot L
authors.initials: EL
authors.lastname: Servais
authors.forename: Nabil P
authors.initials: NP
authors.lastname: Rizk
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Solomon
authors.forename: Camelia S
authors.initials: CS
authors.lastname: Sima
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Park
authors.forename: Stefan S
authors.initials: SS
authors.lastname: Kachala
authors.forename: Maria
authors.initials: M
authors.lastname: Zlobinsky
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
authors.forename: Prasad S
authors.initials: PS
authors.lastname: Adusumilli
mesh_terms: D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling; D015505:Chest Tubes; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D010166:Palliative Care; D016066:Pleural Effusion, Malignant / Q000209:etiology / Q000628:therapy*; D018700:Pleurodesis; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult