gms | German Medical Science

18. Jahrestagung der Deutschen Gesellschaft für Thoraxchirurgie

Deutsche Gesellschaft für Thoraxchirurgie

08.10. bis 10.10.2009, Augsburg

QOL and efficacy of uniportal VATS for malignant pleural effusions

Meeting Abstract

  • Gabriella Giudice - National Cancer Institute Rionero in Vulture, Department of Thoracic Surgery, Rionero in Vulture, PZ, Italien
  • Cosimo Lequaglie - National Cancer Institute Rionero in Vulture, Department of Thoracic Surgery, Rionero in Vulture, PZ, Italien
  • Margherita Garramone - National Cancer Institute Rionero in Vulture, Department of Thoracic Surgery, Rionero in Vulture, PZ, Italien
  • Daniela Marasco - National Cancer Institute Rionero in Vulture, Department of Thoracic Surgery, Rionero in Vulture, PZ, Italien

Deutsche Gesellschaft für Thoraxchirurgie. 18. Jahrestagung der Deutschen Gesellschaft für Thoraxchirurgie. Augsburg, 08.-10.10.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocHS6.7

DOI: 10.3205/09dgt36, URN: urn:nbn:de:0183-09dgt364

Published: November 20, 2009

© 2009 Giudice et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: To determine the safety and long and medium term efficacy of pleurodesis by video-assisted-thoracoscopic (VATS) talc poudrage, as well as its impact on the respiratory function and therefore on the quality of life of the patients with the patient grade of benefit.

Methods: The clinical data collected in this perspective study originate from the record-charts of the Department of Thoracic Surgical Oncology of the National Cancer Institute of Rionero in Vulture, Italy and they belong to an European Multicentric Trial.

From March 2006 to December 2008 100 evaluable cases were included (58 males and 42 females; age range 29–85 years old) on 116 consecutive cancer patients affected from malignant pleural effusion. We excluded 7 cases because entrapped lung after thoracentesis, 5 for poor performance status and the remainders 4 had a slurry talcage by chest drainage.

Lung cancer was the most frequent primary tumor (54 patients) followed by breast cancer recurrences (28 patients); moreover, there were 5 from malignant pleural mesothelioma (MPM), 4 from ovarian cancer, 2 from colic adenocarcinoma, 1 from parotidean carcinoma, 1 from pharyngeal cancer, 3 from no-Hodgkin lymphoma, 2 from pancreatic adenocarcinoma. Twenty-six patients (26%) had previously treated for recurrent pleural effusion.

The disease diagnosis interval and the talc poudrage has been an average of 4.8 weeks with a range between 1 and 24 weeks.

In 14 cases, for the clinical conditions, we performed the VATS by mask anesthesia.

Uniportal access was employed in 84 VATS procedures (84%), 2 accesses in the remaining 16 cases (16%). Ten pericardial windows were performed for cardiac tamponade. Steril talc was used for chemical pleurodesis in 8 g dosage.

All the patients underwent pre and post-operatively chest X-ray, pulmonary functional tests, blood gas analyses, and requested the grade of benefit after pleurodesis procedure.

Results: The effusion was evacuated (media 1580 cc) with a range between 200–5.000 cc in all 100 patients. There were no-surgical neither allergic VATS related complications. In 2 MPM patients occurred locally cutaneous metastases after 30–45 days from procedure.

The mean hospital stay was 4,5 days (range: 2–12 days).

The blood gas analysis pre-talc poudrage had shown a mean concentration of O2 of 72.1 mmHg (range: 42–90 mmHg) while the CO2 mean was of 42.8 mmHg (range: 31.1–58 mmHg). After the treatment the O2 has been climbed little: 74.2 mmHg (range: 51–90.1 mmHg) while the CO2 has gone down to 39.2 mmHg (range: 31.4–48.1) more acceptable. The pre-operative FEV1 mean was 0.862 L/min but post-operative mean of 1.187 L/min.

Ninety patients (90%) referred grave dyspnoea before the VATS procedure; after, 84 patients (93,3%) referred important improving of symptoms but for 6 ones. In the 10 patients with moderate pre-operative dyspnoea, it disappeared in 4 cases, it became mild in 4, no benefit in 1 and it was reported worsening in the last one (Table 1 [Tab. 1]).

The patient’s percentage of free pleural effusion was after 1 month 92.4 %, after 6 months it was 91.1 % and after 1 year it was 75,1%.

Conclusion: The pleurodesis with talc in VATS gives sure positive results in malignant pleural effusions; it is few traumatic and executable even by local anesthesia and it improves above all the respiratory function and, therefore, the quality of life.