Early and late mortality after pleurodesis for malignant pleural effusion

The purpose of this study is to analyze morbidity and mortality and to determine the relative contribution of each of these potential prognosis variables for predicting morbidity and mortality in patients after pleurodesis by thoracotomy or thoracoscopy.

Between March 1, 1996, and January 31, 2001, a total of 70 patients underwent pleurodesis for recurrent malignant pleural effusion. Thoracoscopy was performed in 54 patients (77%); pleurodesis was achieved by pleural abrasion (n = 15), pleurectomy (n = 5), and talc insufflation (n = 34). Thoracotomy was performed in 16 patients (23%) who also needed pleurectomy and decortication for a trapped lung.

Postoperative complications occurred in 24 patients (34%). Factors adversely affecting morbidity with univariate analysis included: three or four metastatic sites (p = 0.003), and thoracotomy (p = 0.009). Factors adversely affecting morbidity with multivariate analysis included: thoracotomy (p = 0.0005) and number of metastatic sites (p = 0.007). Six patient deaths (8.6%) occurred during hospitalization. Factors adversely affecting in-hospital mortality with univariate analysis included: Eastern Cooperative Oncology Group Performance Status 2 to 3 (p = 0.001), lower preoperative serum hemoglobin (p = 0.001), lower preoperative serum albumin (p = 0.0001), and thoracotomy (p = 0.03). Factors adversely affecting in-hospital mortality with multivariate analysis included: preoperative serum albumin less than 60 g/L (p = 0.007) and ECOG Performance Status 2 to 3 (p = 0.008). Twelve patients (17%) died within 90 days after surgery. Factors adversely affecting 3-month mortality with univariate analysis included: ECOG Performance Status 2 to 3 (p = 0.001), lower preoperative serum hemoglobin (p = 0.03), higher preoperative white cells (p = 0.03), lower preoperative serum albumin (p = 0.03), and preoperative thoracentesis more than once per month (p = 0.03). Factors adversely affecting 3-month mortality with multivariate analysis included: ECOG Performance Status 2 to 3 (p = 0.01), preoperative thoracentesis more than once per month (p = 0.03), three or four metastatic sites (p = 0.02), and preoperative white blood cell count > or = 12,000/mm3 (p = 0.03).

Thoracotomy is not indicated in patients with a malignant effusion because of poor survival, a high frequency of complications, and prolonged hospital stay. Pleurodesis thoracoscopy is indicated in patients with good performance status coupled with good nutrition.