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Parietal pleurectomy for malignant pleural effusion

W A Fry1, J D Khandekar

  • 1Section of Thoracic Surgery, Evanston Hospital, Northwestern University Medical School, Illinois, USA.

Annals of Surgical Oncology
|March 1, 1995
PubMed
Summary

Parietal pleurectomy effectively controls recurrent malignant pleural effusions when standard treatments fail. This surgical option offers a solution for patients with persistent malignant pleural effusions, though careful patient selection is crucial due to associated risks.

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Area of Science:

  • Thoracic Surgery
  • Oncology
  • Pulmonology

Background:

  • Malignant pleural effusions are common, often linked to breast, lung, or ovarian cancers.
  • Standard treatment involves pleural space drainage and irritant instillation for pleural symphysis.
  • Standard treatments are not always effective, necessitating alternative interventions.

Purpose of the Study:

  • To evaluate the efficacy of parietal pleurectomy in managing malignant pleural effusions refractory to standard treatment.
  • To assess the outcomes and safety of parietal pleurectomy in a cohort of patients with persistent malignant pleural effusions.

Main Methods:

  • Parietal pleurectomy was performed on 24 patients with malignant pleural effusion unresponsive to standard therapy.
  • The surgical approach was typically axillary thoracotomy, with decortication in some cases.

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  • The patient group comprised 18 women and 6 men, with primary cancers including breast, lung, and ovary.

    • Main Results:

    • Operative mortality was 12.5% (3 out of 24 patients) due to perioperative deaths.
    • Satisfactory control of recurrent malignant effusions was achieved in the remaining 21 patients.
    • Patient survival ranged from 2 to 30 months, with an average of 10.6 months.

    Conclusions:

    • Parietal pleurectomy demonstrates effectiveness in managing recurrent malignant pleural effusions.
    • Due to significant morbidity and mortality, the procedure should be reserved for cases where standard treatments have failed.
    • Careful patient selection is essential for optimizing outcomes and minimizing risks associated with parietal pleurectomy.