title: Current practices in the management of malignant pleural effusions: a survey among members of the European Society of Thoracic Surgeons.
abstract: Malignant pleural effusion (MPE) commonly complicates advanced malignancy and their exact management is still undefined. We undertook a survey to determine the current practice among members of the European Society of Thoracic Surgeons (ESTS).
  
  
  
  A cross-sectional survey focused on the current practice of management of MPE was developed by the authors. The questions were outlined after a review of the literature and circulated in an Internet-based survey format.
  
  
  
  Computed tomography (125, 92%) and chest X-ray (106, 78%) are the most common imaging modalities performed in the initial evaluation. Video-assisted thoracoscopic surgery for washout and pleurodesis (93, 68%) was reported as the preferred approach to patients with uncomplicated MPE. Sixty-one (45%) of the responding colleagues routinely use large bore chest tubes for draining malignant effusions. Forty-nine (35%) surgeons would not apply suction to the drainage system, whilst 50 (37%) would use -2 kPa or less. Talc (124, 91%) is the most commonly used sclerosing agent for pleurodesis in the context of malignant pleural effusion. The practice of 76 (56%) of the respondents is not informed by any clinical guidelines, whilst 60 (44%) reported adhering to the 2010 British Thoracic Society Pleural Disease Guideline. Seventy-one (52%) declared that the guidance was in need of updating or revision.
  
  
  
  This survey demonstrates the lacking adoption of the existing clinical guidance in this field, as well as the need for more contemporary guidelines for a better-informed practice. The ESTS Working Group on the management of MPE has been established for this purpose.
authors.affiliation: Department of Thoracic Surgery, University College London Hospitals, London, United Kingdom.
authors.forename: Marco
authors.initials: M
authors.lastname: Scarci
authors.affiliation: Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
authors.forename: Edward
authors.initials: E
authors.lastname: Caruana
authors.affiliation: Department of Thoracic Surgery, Sacro Cuore, Don Calabria Research Hospital, Negrar, Verona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Bertolaccini
authors.affiliation: Department of Thoracic Surgery, University College London Hospitals, London, United Kingdom.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bedetti
authors.affiliation: Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.affiliation: Department of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Varela
authors.affiliation: Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom.
authors.forename: Kostas
authors.initials: K
authors.lastname: Papagiannopoulos
authors.affiliation: Department of Thoracic Surgery, Jagiellonian University Collegium Medicum, John Paul II Hospital, Cracow, Poland.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Kuzdzal
authors.affiliation: Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Massard
authors.affiliation: Department of Thoracic Surgery, University of Torino, Torino, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.affiliation: Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Pierre Emmanuel
authors.initials: PE
authors.lastname: Falcoz
authors.affiliation: Division of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Opitz
authors.affiliation: Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Batirel
authors.affiliation: Department of Thoracic Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Toker
authors.affiliation: Division of Thoracic Surgery, Department of Thoracic Surgical and Medical Oncology, Istituto Nazionale Tumori, Fondazione Pascale, IRCSS, Naples, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Rocco
mesh_terms: D003430:Cross-Sectional Studies; D019468:Disease Management; D005060:Europe; D006801:Humans; D016066:Pleural Effusion, Malignant / Q000175:diagnosis / Q000601:surgery*; D013902:Radiography, Thoracic; D012955:Societies, Medical; D066231:Surgeons / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery; D019616:Thoracic Surgical Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: Malignant pleural effusion • Survey • ESTS Malignant Pleural
                      Effusion Working Group