I versamenti pleurici neoplastici

Aim. There are several treatments for the malignant pleural effusion according to the individual patient. In this retrospective study we have evaluated the clinical outcome of different treatments. Methods. In secondary pleural malignancy thoracoscopic talc pleurodesis was done in 102 patients (55.4%), pleurectomy by VATS in 5 (2.7%) and a pleuro-peritoneal shunt was performed in 10 (5.4%). In 67 patients (36.5%) we performed talc-slurry. Of the patients with malignant pleural effusion by pleural mesothelioma, thoracoscopic talc pleurodesis was done in 74 (70.4%), decortication in 25 (23.8%), pleuropneumonectomy in 4 (3.8%) and lobectomy plus pleurectomy in 2 (1.9%). Results. Of the thoracoscopic pleurodesis, 68.3% were believed to have an excellent result, 18.7% a good result, 13% a not-satisfactory result. The mean duration of postoperative survival was 6.5 months. Of the talc slurry, 47,8% were believed to have an excellent result, 19.4% a good result, 32.8% a not-satisfactory result. The mean duration of postoperative survival was 4.7 months. In the group of patients treated with pleuroperitoneal shunt we obtained in 70% an excellent result, in 20% a good result and in 10% a not-satisfactory result. The mean duration of postoperative survival was 4.2 months. Conclusion. Thoracoscopic talc pleurodesis is the procedure of choice for effective palliation of malignant pleural effusion. It allows optimal preparation of the pleural surface and homogeneous distribution of the talc maximizing the changes for complete pleurodesis. Patients with lungs trapped may benefit from placement of a pleuro-peritoneal shunt as an alternative.