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 cancer | 98 (51.9) |
| Digestive tract | 38 (20.1) |
| Breast | 23 (12.2) |
| Ovarian | 15 (7.9) |
| Unknown primary | 9 (4.8) |
| Hematologic malignancies | 6 (3.1) |
| Side of implantation, No. (%) | |
| Right | 108 (57.2) |
| Left | 69 (36.5) |
| Bilateral | 12 (6.3) |
| Discharged to, No. (%) | |
| Home | 176 (93.1) |
| Another institution | 13 (6.9) |
| Complications, No. (%) | |
| Pain during drainage, no (%) 5 (5.6%) | 13 (6.3) |
| Local infection | 3 (1.6) |
| Catheter dislocation | 1 (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.
- Copyright ©the authors 2016
