Malignant effusions

2019 ◽  
pp. 525-530
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Treatment Strategies ◽  
Pleural Space ◽  
Presenting Symptoms ◽  
Simple Drainage ◽  
Malignant Effusions ◽  
Peritoneal Lining

In this chapter, malignant effusions are first defined and then characterized into either ascites, where fluid collects in the layers of the peritoneal lining, and malignant pleural effusion where fluid collects within the pleural space in the lining of the lung. The aetiology and common presenting symptoms of both are outlined, before treatment strategies are considered. For both, this generally consists of drainage of the fluid using specific techniques which are described. Methodologies for managing effusions outside of simple drainage are also covered, along with a brief review of the evidence supporting them.

Malignant effusions

2007 ◽  
pp. 539-544
Keyword(s):  
Pleural Effusion ◽  
Metastatic Disease ◽  
Malignant Pleural Effusion ◽  
Pleural Space ◽  
Malignant Effusions ◽  
Short Space

Introduction 540 Malignant pleural effusion 542 Malignant effusions are abnormal collections of fluid. They most commonly occur in the peritoneal or pleural space. They are generally a sign of advanced metastatic disease. They can be managed but the fluid normally reaccumulates, often within a short space of time....

scholarly journals Survival and pleurodesis outcome in patients with malignant pleural effusion – a systematic review

2021 ◽  
Vol 6 (1) ◽  
pp. 1-5
Author(s):  
Maged Hassan ◽  
Elinor Harriss ◽  
Rachel M. Mercer ◽  
Najib M. Rahman
Keyword(s):  
Systematic Review ◽  
Pleural Effusion ◽  
Survival Benefit ◽  
Malignant Pleural Effusion ◽  
Risk Of Bias ◽  
Common Condition ◽  
Survival Difference ◽  
Range Difference ◽  
Simple Drainage

Abstract Malignant pleural effusion (MPE) is a common condition that presents with progressive breathlessness. Long term solutions are often required due to recurrence of effusion after simple drainage. Pleurodesis is one of the main options resorted to for long term control of MPE. There is data to suggest there may be a survival benefit for patients with MPE who achieve successful pleurodesis. A systematic review was carried out to explore this correlation and results suggest that there could be a survival difference according to pleurodesis outcome in patients with MPE. Fifteen studies (reported in 13 papers) were included; 13 (86.6%) of the studies showed survival difference in favour of pleurodesis success. The median [interquartile range] difference in survival between the two groups among the different studies was five [3.5–5.8] months. Most of the included studies suffered moderate to severe risk of bias and, thus, large prospective studies of patients undergoing pleurodesis are required to ascertain this effect.

Management of malignant pleural effusion. A retrospective study comparing efficiency and outcomes of VATS talcum pleurodesis, insertion of tunneled pleural catheter (PleurX®), and a combination of both

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
L F Azenha Figueiredo ◽  
S Deckarm ◽  
G Kocher
Keyword(s):  
Pleural Effusion ◽  
Length Of Stay ◽  
Malignant Pleural Effusion ◽  
Treatment Strategies ◽  
Secondary Outcome ◽  
Oncological Disease ◽  
Day Range ◽  
Significant Difference ◽  
Pleural Catheter ◽  
Talcum Pleurodesis

Abstract Objective The management of malignant pleural effusion is a common problem in thoracic surgery. Patients are often polymorbid and are usually referred at a terminal stage of their oncological disease. Our objective was to compare the efficiency and outcomes after different treatment strategies of malignant pleural effusion. Methods We retrospectively reviewed the charts of a total of 416 patients treated during the period of 2010 to 2020 who underwent thoracoscopic pleurodesis with or without implantation of tunneled pleural catheter (TPC) as well as patients who underwent the implantation of TPC alone. Primary outcome was postoperative survival and secondary outcome was length of stay (LOS). In addition, we documented the recurrence of ipsilateral pleural effusion and the need for reintervention as well as the pulmonary reexpansion of the lung on postoperative chest x-ray. Inclusion criteria were malignant pleural effusion and documented follow-up until time of death. Exclusion criteria were treatment for mesothelioma, pneumothorax and emphysema. Results A total of 199 patients were included for analysis. Median LOS of patients treated with implantation of TPC alone in analgosedation (n = 28) was 1 day (range:1-4 days). Median LOS of patients who received video-assisted talcum pleurodesis (n = 65) without implantation of a TPC was 6 days (range 1-38 days). Median LOS of patients who received VATS talcum pleurodesis and TPC (n = 106) was 3 days (range 1-34 day). The difference in LOS was statistically significant (p < 0.05). Median overall survival was 108 days (range 3-3001 days). There was no statistically significant difference in survival between the different treatment groups (p = 0.47). Conclusion The primary goal when treating patients with malignant pleural effusion is relief of dyspnea and/or pain and to keep the duration of the inpatient treatment to a minimum. In patients with a considerable surgical risk due to comorbidities and their underlying oncological disease and who don’t require the sampling of histological material, a conservative treatment option with implantation of a TPC can be sufficient. The additional insertion of a TPC not only reduces the length of stay, but also has a positive effect on the efficacy of the pleurodesis in terms of less recurrence. We therefore recommend the routine use of TPC when performing VATS talcum pleurodesis in patients with malignant pleural effusion.

Management of pleural effusion and haemothorax

2016 ◽  
Author(s):  
Davide Chiumello ◽  
Silvia Coppola
Keyword(s):  
Pleural Effusion ◽  
Symptomatic Relief ◽  
Underlying Disease ◽  
Pleural Space ◽  
Bacterial Invasion ◽  
Pleural Effusions ◽  
Management Options ◽  
External Drainage ◽  
Malignant Effusions ◽  
Pleural Catheter

The main goal of management of pleural effusion is to provide symptomatic relief removing fluid from the pleural space. The options depend on type, stage, and underlying disease. The first diagnostic instrument is the chest radiography, while ultrasound can be very useful to guide thoracentesis. Pleural effusion can be a transudate or an exudate. Generally, a transudate is uncomplicated effusion treated by medical therapy, while an exudative effusion is considered complicated effusion and should be managed by drainage. Refractory non-malignant effusions can be transudative (congestive heart failure, cirrhosis, nephrosis) or exudative (pancreatitis, connective tissue disease, endocrine dysfunction), and the management options include repeated therapeutic thoracentesis, in-dwelling pleural catheter for intermittent external drainage, pleuroperitoneal shunts for internal drainage, or surgical pleurectomy. Parapneumonic pleural effusions can be classified as complicated when there is persistent bacterial invasion of the pleural space, uncomplicated and empyema with specific indications for pleural fluid drainage. Malignancy is the most common cause of exudative pleural effusions in patients aged >60 years and the decision to treat depends upon the presence of symptoms and the underlying tumour type. Options include in-dwelling pleural catheter drainage, pleurodesis, pleurectomy, and pleuroperitoneal shunt. Haemothorax needs to be differentiated from a haemorrhagic pleural effusion and, when suspected, the essential management is intercostal drainage. It achieves two objectives to drain the pleural space allowing expansion of the lung and to allow assessment of rates of blood loss to evaluate the need for emergency or urgent thoracotomy.

scholarly journals Novel pleural-bladder pump in malignant pleural effusions: from animal model to man

Thorax ◽  
2020 ◽  
Vol 75 (5) ◽  
pp. 432-434 ◽  
Author(s):  
Philippe Astoul ◽  
Sophie Laroumagne ◽  
Jeroen Capel ◽  
Nicholas A Maskell
Keyword(s):  
Quality Of Life ◽  
Animal Model ◽  
Pleural Effusion ◽  
Management Strategy ◽  
Malignant Pleural Effusion ◽  
Pleural Space ◽  
Optimal Management ◽  
Pleural Effusions ◽  
Pump System

Malignant pleural effusion is common and causes disabling symptoms such as breathlessness. Treatments are palliative and centred around improving symptoms and quality of life but an optimal management strategy is yet to be universally agreed. A novel pump system, allowing fluid to be moved from the pleural space to the urinary bladder, may have a role for the management of recurrent malignant pleural effusion. We hereby describe the first animal study using this device and the results of the first application in patients.

Pathophysiology and causes of haemoptysis

2016 ◽  
Author(s):  
Francesco Blasi ◽  
Paolo Tarsia
Keyword(s):  
Pleural Effusion ◽  
Symptomatic Relief ◽  
Underlying Disease ◽  
Pleural Space ◽  
Bacterial Invasion ◽  
Pleural Effusions ◽  
Management Options ◽  
Indwelling Pleural Catheter ◽  
Malignant Effusions ◽  
Pleural Catheter

The main goal of management of pleural effusion is to provide symptomatic relief removing fluid from pleural space and the options depend on type, stage and underlying disease. The first diagnostic instrument is the chest radiography while ultrasound can be very useful to guide thoracentesis. Pleural effusion can be a transudate or an exudate. Generally a transudate is uncomplicated effusion treated by medical therapy, while an exudative effusion is considered complicated effusion and should be managed by drainage. Refractory non-malignant effusions can be transudative (congestive heart failure, cirrhosis, nephrosis) or exudative (pancreatitis, connective tissue disease, endocrine dysfunction), and the management options include repeated therapeutic thoracentesis, indwelling pleural catheter for intermittent external drainage, pleuroperitoneal shunts for internal drainage, or surgical pleurectomy. Parapneumonic pleural effusions can be divided in complicated when there is persistent bacterial invasion of the pleural space, uncomplicated and empyema with specific indications for pleural fluid drainage. Malignancy is the most common cause of exudative pleural effusions in patients aged >60 years and the decision to treat depends upon the presence of symptoms and the underlying tumour type. Options include indwelling pleural catheter drainage, pleurodesis, pleurectomy and pleuroperitoneal shunt. Hemothorax needs to be differentiated from a haemorrhagic pleural effusion and when is suspected the essential management is the intercostal drainage. It achieves two objectives to drain the pleural space allowing expansion of the lung and to allow assessment of rates of blood loss to evaluate the need for emergency or urgent thoracotomy.

scholarly journals P-218ELASTANCE OF THE PLEURAL SPACE COMPARED TO CLINICAL JUDGEMENT AS A PREDICTOR OF PLEURODESIS OUTCOME IN PATIENTS WITH MALIGNANT PLEURAL EFFUSION

2015 ◽  
Vol 21 (suppl_1) ◽  
pp. S59-S59
Author(s):  
Carlos Martinez-Barenys ◽  
E. Cladellas ◽  
S. Garcia Reina ◽  
P. Serra ◽  
F. Andreo ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Pleural Space ◽  
Clinical Judgement

scholarly journals Survival and pleurodesis outcome in patients with malignant pleural effusion – a systematic review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Maged Hassan ◽  
Elinor Harriss ◽  
Rachel M. Mercer ◽  
Najib M. Rahman
Keyword(s):  
Systematic Review ◽  
Pleural Effusion ◽  
Survival Benefit ◽  
Malignant Pleural Effusion ◽  
Risk Of Bias ◽  
Common Condition ◽  
Survival Difference ◽  
Range Difference ◽  
Simple Drainage

Abstract Malignant pleural effusion (MPE) is a common condition that presents with progressive breathlessness. Long term solutions are often required due to recurrence of effusion after simple drainage. Pleurodesis is one of the main options resorted to for long term control of MPE. There is data to suggest there may be a survival benefit for patients with MPE who achieve successful pleurodesis. A systematic review was carried out to explore this correlation and results suggest that there could be a survival difference according to pleurodesis outcome in patients with MPE. Fifteen studies (reported in 13 papers) were included; 13 (86.6%) of the studies showed survival difference in favour of pleurodesis success. The median [interquartile range] difference in survival between the two groups among the different studies was five [3.5–5.8] months. Most of the included studies suffered moderate to severe risk of bias and, thus, large prospective studies of patients undergoing pleurodesis are required to ascertain this effect.

scholarly journals Pleural Space Elastance and Its Relation to Success Rates of Pleurodesis in Malignant Pleural Effusion

2021 ◽  
Vol 84 (1) ◽  
pp. 67-73
Author(s):  
Hossam Hosny Masoud ◽  
Mahmoud Mohamed El-Zorkany ◽  
Azza Anwar Ahmed ◽  
Hebatallah Hany Assal
Keyword(s):  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Pleural Space ◽  
Success Rates
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