Video-assisted thoracoscopic pleurectomy in the management of malignant pleural effusion

To evaluate the outcome of pleurectomy using video-assisted thoracic surgery (VATS) for pleurodesis in patients with malignant pleural effusion.

Cohort prospective study. Follow-up of patients from referral for thoracoscopy to death.

Regional Cardiothoracic Surgical Centre.

Nineteen patients (median age 63 years, range 51 to 84 years) with malignant pleural effusion, secondary to mesothelioma in 13 and metastatic adenocarcinoma in 6.

Video-assisted parietal pleurectomy.

Median operating time was 35 min (range 15 to 60 min). The median fall in hemoglobin concentration in the first 24 h postsurgery was 1.1 g/dL (0.3-2.5 g/dL). The median postoperative morphine requirement was 1.25 mg/h (0-6.2 mg/h) in the first 12 h postoperatively. All patients were successfully extubated in the operating room, without the need for reventilation, and all patients were successfully discharged from the hospital with a median postoperative stay of 5 days (range 2 to 20 days). At current median follow-up of 12 months (range 4 to 17 mon) 6 patients died of their underlying disease. In the remaining 13 patients, two have developed recurrent effusions.

Using VATS to perform parietal pleurectomy is a safe, effective method of obtaining palliative pleurodesis in patients with malignant effusions.