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Outpatient management of malignant pleural effusion in patients unfit for pleurodesis

Luca Bertolaccini, Andrea Viti, Simona Paiano, Luca Rosario Assante, Carlo Pomari, Alberto Terzi
European Respiratory Journal 2016 48: PA2527; DOI: 10.1183/13993003.congress-2016.PA2527
Luca Bertolaccini
1Thoracic Surgery Unit, Sacro Cuore – Don Calabria Research Hospital, Negrar Verona, VRItaly
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Andrea Viti
1Thoracic Surgery Unit, Sacro Cuore – Don Calabria Research Hospital, Negrar Verona, VRItaly
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Simona Paiano
2Thoracic Endoscopy Unit, Sacro Cuore – Don Calabria Research Hospital, Negrar Verona, VRItaly
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Luca Rosario Assante
2Thoracic Endoscopy Unit, Sacro Cuore – Don Calabria Research Hospital, Negrar Verona, VRItaly
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Carlo Pomari
2Thoracic Endoscopy Unit, Sacro Cuore – Don Calabria Research Hospital, Negrar Verona, VRItaly
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Alberto Terzi
1Thoracic Surgery Unit, Sacro Cuore – Don Calabria Research Hospital, Negrar Verona, VRItaly
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Abstract

BACKGROUND: Multidisciplinary cancer teams regularly treat patients with Malignant Pleural Effusion(MPE)

Uniportal VATS talc poudrage is the standard of care for fit patients being talc slurry reserved to unfit for surgery

AIMS: In patients unfit for pleurodesis (low-performance status/comorbidity),recurrent MPE after pleurodesis,trapped lung,outpatient management through subcutaneous tunneled indwelling pleural catheter (IPC) could be used

METHODS: From 2001, 189 patients referred for IPC with histological/cytological confirmed MPE

Contraindications: mesothelioma,coagulopathy,skin infection,loculated effusions

IPC placed under local anesthesia

Weekly fluid evacuation recommended

District nurses management on outpatient

RESULTS: All reported reduction in dyspnea/improvement of well-being

All discharged in the same implantation day

Minor complications in 9% (no IPC metastatic seeding)

Mean duration of drainage 54 days (range 21-296)

Pleurodesis achieved in 81 (42.9%) after median time of 54 days (range 31-83)

Mean survival 184 days (range 21-296)

Demographic characteristics
Mean age, years (range)67 (43 – 86)
M/F (%)69.3
Primary malignancy, No. (%)
Non-small cell lung cancer98 (51.9)
Digestive tract38 (20.1)
Breast23 (12.2)
Ovarian15 (7.9)
Unknown primary9 (4.8)
Hematologic malignancies6 (3.1)
Side of implantation, No. (%)
Right108 (57.2)
Left69 (36.5)
Bilateral12 (6.3)
Discharged to, No. (%)
Home176 (93.1)
Another institution13 (6.9)
Complications, No. (%)
Pain during drainage, no (%) 5 (5.6%)13 (6.3)
Local infection3 (1.6)
Catheter dislocation1 (0.5)

CONCLUSIONS: In end-stage cancers, treatment of MPE with IPC improves quality of life

Complication rate is low and IPC can be safely managed at home.

  • Surgery
  • Pleura
  • Thoracic oncology
  • Copyright ©the authors 2016
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Outpatient management of malignant pleural effusion in patients unfit for pleurodesis
Luca Bertolaccini, Andrea Viti, Simona Paiano, Luca Rosario Assante, Carlo Pomari, Alberto Terzi
European Respiratory Journal Sep 2016, 48 (suppl 60) PA2527; DOI: 10.1183/13993003.congress-2016.PA2527

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Outpatient management of malignant pleural effusion in patients unfit for pleurodesis
Luca Bertolaccini, Andrea Viti, Simona Paiano, Luca Rosario Assante, Carlo Pomari, Alberto Terzi
European Respiratory Journal Sep 2016, 48 (suppl 60) PA2527; DOI: 10.1183/13993003.congress-2016.PA2527
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