Recurrent pleural effusion: who benefits from a tunneled pleural catheter?

Area of Science:

• Thoracic Surgery
• Pulmonology
• Palliative Care

Background:

• Recurrent malignant pleural effusion (MPE) significantly impacts patient quality of life and increases morbidity.
• Existing treatments for MPE can be limited, especially in patients with impaired lung expansion.

Purpose of the Study:

• To evaluate the safety and efficacy of tunneled indwelling pleural catheters (TIPC) for managing recurrent benign and malignant pleural effusions.
• To identify patient subgroups that most benefit from TIPC placement.

Main Methods:

• A retrospective analysis of 100 consecutive patients treated with TIPC for recurrent pleural effusions (88 malignant, 12 benign).
• Catheter placement was performed via video-assisted thoracoscopic surgery (VATS) or an open technique under local anesthesia.
• Data collected included catheter dwell time, complication rates, and outcomes such as spontaneous pleurodesis.

Main Results:

• The median TIPC dwell time was 70 days, with spontaneous pleurodesis occurring in 29 patients.
• Complications were infrequent, including 4 cases of pleural empyema, 2 of accidental dislodgement, and 3 of drainage malfunction.
• TIPC demonstrated a low complication rate and was effective in managing recurrent effusions.

Conclusions:

• TIPC is a valuable palliative treatment option for patients with recurrent malignant or nonmalignant pleural effusions.
• Patients who benefit most include those with intraoperative trapped lungs, a history of failed pleurodesis or repeated thoracenteses, and those with a limited prognosis.