Tunneled pleural catheters for treatment of recurrent malignant pleural effusion following failed pleurodesis.

PURPOSE

To evaluate patient outcomes when tunneled pleural drainage catheters are placed for symptomatic, recurrent malignant pleural effusion following failed chemical pleurodesis.

MATERIALS AND METHODS

Two hundred seventy patients who underwent placement of a tunneled pleural catheter between January 2002 and December 2006 were retrospectively identified by reviewing interventional radiology billing records with institutional review board approval. Of these 270 patients, 63 (68 hemithoraces; 44 women, 19 men) with dyspnea were referred for tunneled pleural drainage catheter placement following failed pleurodesis for malignant pleural effusion. Clinical and procedural details were identified by chart review. Endpoints were technical success, symptomatic improvement in dyspnea, time to hospital discharge, and time to catheter removal or time to death with the catheter in place.

RESULTS

Clinical improvement in dyspnea was noted in 60 of the 63 patients (95%). Fifty-seven of the 63 patients (90%) were discharged with their catheter in place after a median of 3 days (range, 0-29 days). Twenty-seven of the 63 patients (43%) were discharged in 2 days or less. Stays longer than 2 days were all associated with treatment of other medical problems. Twenty-one of the 68 catheters (31%) required fibrinolytic therapy for optimal evacuation of complex pleural collections. Eleven of the 68 catheters (16%) could subsequently be removed due to durable resolution of pleural effusion. The remaining patients died with catheters in place and no clinical evidence of catheter dysfunction after a median of 58 days.

CONCLUSIONS

Even following failed pleurodesis, recurrent malignant pleural effusions can be effectively managed with placement of tunneled pleural catheters.