e17542 Background: Patients with lung adenocarcinoma and malignant pleural effusions have limited life expectancy. The treatment of lung adenocarcinoma with malignant pleural effusions remains controversial. The purpose of our study is to evaluate the use of video-assisted thoracoscopy to perform hyperthermic intrapleural chemotherapy combined with Endostar (recombinant human endostatin) for disseminated pleural adenocarcinoma. Methods: From 2007 to 2010, there were 46 patients with lung adenocarcinoma and pleural dissemination undergoing thoracoscopic surgery and intrathoracic hyperthermic perfusion with chemotherapy in combination of Endostar. After thoracoscopic surgery, the hyperthermic perfusion system was set up for hyperthermic intrapleural chemotherapy. The thoracic cavity was perfused at a speed of approximately 1.8-2.3 L/min with 0.9% normal saline (4-5L), containing cisplatinum (100 mg). The intrathoracic temperature remained between 42°C to 43°C. This process of perfusion lasted for 1 hours. Following this, 2L of 0.45% saline with Endostar (30 mg) at a temperature of 30 °C was put into the pleural cavity and kept for 30 min. Results: There were no peri-operative deaths. During the hyperthermic perfusion, patient's core temperature varied from 36.3ºC and 39.3ºC and pulse from 59 beats/m and 126 beats/m. Intraoperative sinus tachycardia occurred in 2 elderly cases. No hematologic toxicity and nephrotoxicity was observed within one week after surgery. Postoperative pneumonia occurred in 1 elderly case. The median survival time was 21 months. During the follow-up period, only one patient suffered from continuing pleural effusion due to atelectasis, one elderly patient died of heart failure one year after surgery and the remaining patients were completely free from pleural effusion during the last follow-up. Conclusions: Hyperthermic intrapleural chemotherapy combined with Endostar by thoracoscopic surgery offers a safe and effective treatment for lung adenocarcinoma with pleural dissemination. It may be time-consuming, but beneficial and may have an encouraging impact on its long-term survival.
Video-assisted thoracoscopic diagnosis of trapped lung in malignant pleural effusions
