Video-assisted thoracoscopic (VATS) pleurodesis for malignant effusion: an Australian teaching hospital's experience.

Abstract

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 (>or=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 >or=4 have a poor overall outcome and warrant less invasive palliative measures.