1397P - Chronic pleural effusion in malignancy: A single center’s ten years expertise with indwelling pleural catheters

Abstract

Background: Chronic and recurrent pleural effusion (PE) in malignant diseases is a common cause of dyspnea, cough and chest pain. The vast majority is malignant pleural effusion (MPE), nevertheless disease-associated but not directly disease-caused paramalignant pleural effusions (PPE) have also been described. Talc pleurodesis had been the only treatment option for decades, while for 20 years indwelling pleural catheters (IPC) have emerged as an alternative leading to spontaneous pleurodesis without any chemical agent in 40-50%. Methods: Our aim is to explore patient characteristics, procedural variables and outcomes in a large population of patients with IPC due to PE in malignancy. Further, our objective is to identify factors associated with outcome. Results: From 2006 until 2016 448 IPC were inserted in 395 patients, 52 received bilateral drainages (12.7%). 77.0% of the effusions were malignant (n = 304), 14.9% paramalignant (n = 59), in 8.1% the etiology could not be clarified (n = 32). The most common underlying diseases were ovarian cancer (30.6%, 121 patients), lung cancer (23.0%, 91 patients) and breast cancer (11.4%, 45 patients). The median length of insertion was 1.2 months (0.03-23.6), the median survival time after insertion 2.4 months (lung cancer 1.6 months, ovarian cancer 2.8 months, breast cancer 4.0 months). Spontaneous pleurodesis was observed in 28.6% (128/448 catheters) and was significantly associated with overall survival (HR 0.54, 95%-CI 0.39-0.75, p < 0.001). Complications occurred in 12.3% of all procedures (55/448 catheters), in 6.5% the catheter had to be removed (29/448 catheters). The most common complications were superficial infections (n = 14), empyema (n = 11; 1 grade 5 complication) and mechanical obstruction of the catheter (n = 13). Conclusions: In conclusion, our retrospective series is the largest to date to report on IPC in malignancy and showed a manageable safety profile. Spontaneous pleurodesis was significantly associated with survival. Legal entity responsible for the study: Charité Universitätsmedizin Berlin Funding: None Disclosure: All authors have declared no conflicts of interest. Keywords: pleurodesis, chronic pleural effusion, indwelling pleural catheter