Multimodality treatment including parietal pleurectomy as a possible therapeutic procedure for malignant pleural effusion.

Long-term control of malignant pleural effusion is an important goal of therapy in patients with pleural dissemination. The authors have carried out limited operations combined with parietal pleurectomy (PL) for non-small cell lung cancer patients with pleural dissemination, based on the hypothesis that the most effective target area for controlling malignant pleural effusion is the parietal pleura. In our 25 years of experience, 54 patients with pleural dissemination (26 also had malignant pleural effusion) have undergone this surgical treatment. The operative procedures used for resection of lung parenchyma were partial resection in 25 patients, lobectomy in 24, bilobectomy in two, segmentectomy in two, and no parenchymal resection (PL only) in one. Postoperative intrapleural chemotherapy and systemic chemotherapy (2-4 cycles) also were applied in 43 patients. The pathological stages were IIIB in 44 patients and IV in ten. The overall three-, five-, and ten-year survival rates were 29.0%, 15.0%, and 7.5%, respectively. Twenty patients survived for more than two years. Recurrent malignant pleural effusion developed in only two of 30 patients whose recurrent patterns could be clearly identified. Although this was not a clinical randomized comparative study, multimodality treatment that included the use of PL appears to be a useful option for treatment of this disease in appropriately selected patients.