The utility of a pleural carcinomatosis score for assessing resectability

Malignant pleural effusion is a common evolution of various cancers and is associated with poor prognosis and quality of life. Currently, the surgical approach is mainly palliative, involving videothoracoscopic talc pleurodesis or the insertion of indwelling pleural catheters. No surgical options with a curative intent are validated for this indication. The aim of our study was to evaluate a score for assessing resectability in pleural carcinomatosis.

122 consecutive patients with recurrent symptomatic pleural effusion, referred to our thoracic surgery department for a surgical exploration of the pleura, were prospectively included. Each patient underwent a detailed description of videothoracoscopic findings, which were summarized in our pleural carcinomatosis score. Resectability was then discussed in our surgical staff meeting.

Eighty patients (65.6 %) were diagnosed with metastatic pleural spread, while 42 patients were diagnosed with benign pleural disease (34.4 %). Patients diagnosed with benign pleural effusion had a median score of 2, and 29 patients (69 %) were considered resectable. Patients diagnosed with malignant pleural effusion had a median score of 11, and only 13 patients (16.2 %) were considered resectable. Those deemed resectable had a median score of 5. The threshold for resectability in our score was set at 6.

The meticulous exploration of the pleura and calculation of the pleural carcinomatosis score could aid in selecting patients for curative-intent surgery. Patients with a score equal to or less than 6 should be discussed in a multidisciplinary tumor board where the possibility of surgery is considered.