[Surgical therapy for malignant pleural effusions]

Abstract

Symptomatic malignant pleural effusions are common in patients with neoplastic disease (50 %). Frequently, they are a sign of advanced disease. These patients have an average life expectancy of 3 to 12 months. The therapeutic aim should be an efficient treatment with a short hospital stay. Chest tube drainage gives rapid relief of symptoms and information on the expansion of the lungs. When complete expansion of the lung is possible, VATS insufflation of talc is recommended. Talc is the most effective sclerosant (80 %) followed by doxycycline (70 %). VATS pleurodesis has a higher complication rate but is more effective than a talc slurry instilled through the chest tube. When the lung is trapped, long-term indwelling pleural drainage and pleuroperitoneal shunts are alternatives.