Surgical options for treating malignant pleural eff usion in patients with breast carcinoma Comparison of methods

Abstract

Background: Recurrent malignant pleural eff usion (MPE) is a common complication of breast carcinoma causing an irritating cough and pain due to the fl uid exerting pressure on the lungs. As the systemic therapy fails in approximately half of the patients with pleural eff usion, one of the palliative methods is used. Lately, the most commonly used procedure is the chemical pleurodesis with talc or the thoracoscopic mechanical pleurodesis. Th e aim of the study was to prove certain advantages of the latter method, especially at lower MPE pH values, since the chemical pleurodesis in those cases does not provide acceptable results. Methods: Th is prospective, randomized study included 87 patients with breast carcinoma and morphologically proven malignant pleural eff usion. Patients were divided into two groups according to palliative treatment: the TMP group (thoracoscopic mechanical pleurodesis) and the TP group (talc pleurodesis). Th ere were also four subcategories according to the pH value of malignant pleural eff usion (≥ 7.3, < 7.3). Results: Th e eff ectiveness (no recurrence of pleural eff usion) of TP (91 %) and TMP (92 %) was identical in patients with a MPE pH value above 7.3. However, in patients with pH value under 7.3 TMP was more successful (81 %) than TP (55 %). Th e lowest pH values at which the methods proved successful were 7.06 in TMP and 7.25 in TP. Conclusion: TP proved to be a more useful palliative method in patients with pH values above 7.3 due to its simplicity. On the other hand, TMP is more successful at lower pH values. Furthermore, TMP is also very eff ective in the group of patients with higher pH values, especially for handling cytologically or histologically unconfi rmed malignant pleural eff usions and in suspected adhesions in the pleural space.