Primary treatment of malignant pleural effusions: video-assisted thoracoscopic surgery poudrage versus tube thoracostomy.

Abstract

The objective of this study is to show that primary treatment of malignant pleural effusions secondary to ovarian carcinoma with video-assisted thoracoscopic surgery (VATS)-assisted talc poudrage (VATS-ATP) results in shorter hospital stays and reduced time with a chest tube than primary treatment with a chest tube and chemical pleurodesis. We conducted a retrospective chart review of all patients with a symptomatic pleural effusion secondary to primary ovarian carcinoma receiving intervention from January 1996 to December 2000. Patients either received tube thoracostomy with pleurodesis (n = 22) or VATS-ATP (n = 12). Of the patients treated with tube thoracostomy 18 per cent (4/21) died in the hospital before pleurodesis, 77 per cent (14/19) had successful pleurodesis, and 22 per cent (4/18) failed pleurodesis requiring VATS-ATP. In the group treated primarily with tube thoracostomy the chest tube was in place 8.36 +/- 2.61 days with a hospital stay of 12.64 +/- 5.80 days after the procedure. In the group treated with VATS-ATP there was 100 per cent successful pleurodesis. There were no mortalities. There was one prolonged intubation of 3 days and one incomplete lung reexpansion. The chest tube was in place for 4.58 +/- 1.78 days and a hospital stay of 7.50 +/- 4.12 days postprocedure. Groups treated by tube thoracostomy and VATS were statistically different; P < 0.001 for days with a chest tube and P = 0.011 for hospital days. We conclude that both tube thoracostomy with chemical pleurodesis and VATS-ATP provide adequate treatment of ovarian carcinoma-associated malignant pleural effusions. VATS-ATP provides a shorter duration of chest tube placement and postprocedure hospital stay.

• Authors: Kurt V Erickson, Michael Yost, Raymond Bynoe, Carl Almond, James Nottingham
• Journal: The American surgeon (Am Surg) Vol. 68 Issue 11 Pg. 955-9; discussion 959-60 (Nov 2002) ISSN: 0003-1348 [Print] United States
• PMID: 12455787 (Publication Type: Journal Article)

Chemical References

• Talc

Topics

• Aged
• Algorithms
• Chest Tubes
• Female
• Humans
• Length of Stay
• Middle Aged
• Ovarian Neoplasms (pathology)
• Pleural Effusion, Malignant (etiology, surgery, therapy)
• Pleurodesis
• Retrospective Studies
• Talc (therapeutic use)
• Thoracic Surgery, Video-Assisted
• Thoracostomy
• Treatment Outcome