Chest
Volume 129, Issue 2, February 2006, Pages 362-368
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Original Research
Single-Center Experience With 250 Tunnelled Pleural Catheter Insertions for Malignant Pleural Effusion

https://doi.org/10.1378/chest.129.2.362Get rights and content

Introduction

Malignant pleural effusions (MPEs) are a common cause of dyspnea in patients with advanced cancer. Tunnelled pleural catheters (TPCs) can be used in patients with this condition, but the published experience with them is limited.

Objective

To describe the use of TPCs in the management of MPE in a large group of patients in a clinical setting.

Methods

Retrospective analysis of 250 sequential TPC insertions in patients with MPEs in a single center.

Results

Two hundred fifty TPC procedures for MPE were performed in 223 patients (19 contralateral procedures and 8 repeat ipsilateral procedures) during a 3-year period. Symptom control was complete following 97 procedures (38.8%), was partial in 125 procedures (50%), and was absent in 9 procedures (3.6%); in addition, there were 10 failed TPC insertions (4.0%) and 9 TPC insertions (3.6%) without assessment of symptoms at the 2-week follow-up visit. Spontaneous pleurodesis occurred following 103 of the 240 successful TPC procedures (42.9%) and was more frequent when ≤ 20% of the hemithorax contained fluid at the 2-week follow-up visit (57.2% vs 25.3%, respectively; p < 0.001). Catheters stayed in place for a median duration of 56 days. Following successful TPC placement, no further ipsilateral pleural procedures were required in 90.1% of cases. The overall median survival time following TPC insertion was 144 days. Complication rates were low and compared favorably with those seen with other treatment options.

Conclusions

TPC placement is an effective method of palliation for MPE that allows outpatient management and low complication rates. The insertion of a TPC should be considered as a first-line treatment option in the management of patients with MPE.

Section snippets

Overview

TPCs were introduced in our center in October 2001. In order to evaluate this new treatment approach, a prospective database was developed and maintained to track procedure volumes, short-term results, and complications. The database was closed in November 2004 after 250 procedures had been logged. A retrospective review of all procedures and records was performed with the approval of the Conjoint Health Research Ethics Board of the University of Calgary.

Clinical Approach

The use of TPCs in this center was

Results

Between October 2001 and November 2005, 250 TPC procedures for the management of patients with MPEs were performed in 223 patients (19 contralateral procedures and 8 repeat ipsilateral procedures). At the time of analysis, all patients had died or had the TPC removed except for two patients, one of whom had undergone bilateral TPC insertion. Patient demographic data and tumor cell type are described in Table 1.

Discussion

The development of MPE is an event that is associated with short life expectancy and significant morbidity. The options for palliation of this condition have previously included repeated therapeutic thoracentesis, chest tube drainage followed by instillation of a sclerosing agent into the pleural space, and thoracoscopy.

The performance of repeated thoracentesis procedures is rarely the optimal approach for palliative care in patients with MPE. By definition, procedures are symptom-prompted,

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