Management of malignant pleural effusions with pleuroperitoneal shunting

Malignant pleural effusions are often debilitating conditions for the patient with advanced carcinoma. Traditionally, treatment has been repeated thoracentesis or tube thoracostomy with instillation of sclerosing agents. However, this required the patient to be hospitalized and to have pain and inconveniences of the chest tubes. The drainage also had to be low enough for sclerotherapy to be effective. In 1982, the pleuroperitoneal shunt became a feasible alternative to sclerotherapy. We began using the Denver pleuroperitoneal shunt in July 1991. Twenty shunts were inserted into 19 patients during a two year period ending June 30, 1993. All patients but one were relieved of dyspnea. The mean duration of patency was 26 months and fewer than 25 percent of the shunts clotted before the death of the patient. Our favorable experience with the shunt has resulted in us recommending the Denver pleuroperitoneal shunt for treatment of recurrent malignant pleural effusions and selectively as primary treatment.