Video-Assisted Thoracoscopic (VATS) Pleurodesis for Malignant Effusion: An Australian Teaching Hospital's Experience

摘要

Video-assisted thoracoscopic surgery (VATS) is commonly employed to achieve pleurodesis in patients suffering malignant pleural effusion (MPE).Aims. To evaluate the utility and outcome of VATS pleurodesis in management of MPE.Two hundred and two consecutive VATS pleurodesis for MPE were evaluated. Data was derived from a prospectively maintained database and hospital records. Pleurodesis was deemed unsuccessful if a significant effusion occurred within 30 days of surgery.VATS pleurodesis was successful in 88% of patients (failure 12%) while recurrence of effusion occurred in 18%. Post-operative air space, air leak, empyema and prolonged intercostal catheter drainage (>14 days) were all significantly associated with a failed procedure.Mean length of stay was 10.4 days and 42% of patients were discharged within 7 days of surgery. Morbidity was 20% with no operative deaths and median survival was 94 days. Inpatient mortality was 5%. High ASA (>4) was significantly associated with increased risk of inpatient death (p < 0.001) and poorer long-term survival (43 days versus 133 days, p = 0.05).VATS pleurodesis offers reasonable palliation of MPE with low morbidity and rapid recovery. Patients with an ASA score of >4 have a poor overall outcome and warrant less invasive palliative measures.