ES19.05 Surgical Management of Malignant Pleural Effusion

Abstract

At first glance, it would seem that the thoracic surgeon has little role to play nowadays in the management of malignant pleural effusion (MPE). Substantial advances have been made in the understanding of the pathophysiology of MPE and its diagnosis. There is broad consensus that pleurodesis should generally be given at the bedside rather than in the operating theatre, while intractable cases can be managed with indwelling catheters. Even where interventions into the chest are required, the advent of ‘medical’ thoracoscopy appears to have diminished the role of surgeons in managing MPE. However, it would be wrong to presume that thoracic surgeons may be completely excluded from the MPE scene. There remain situations were surgery is still required for a definitive diagnosis or effective palliation. Surgeons continue to have more extensive experience with biopsy, drainage, and ‘rapid pleurodesis’ – yielding high rates of success. More importantly, minimally invasive Video-Assisted Thoracic Surgery (VATS) has evolved significantly in recent years. Uniportal VATS is becoming increasingly utilized and is often complemented by technological advances such as non-intubated anesthesia. The latest advances in minimally invasive thoracic surgery have ensured that the high success rate of surgery is now coupled with surprisingly little – if any – functional or physiological ‘cost’ to the patient with MPE. The ‘VATS’ available today is not the same VATS from even a few years ago. This presentation provides an overview of the current surgical options available in the management of MPE. The modern thoracic surgeon remains fully equipped and prepared to contribute to the multi-disciplinary care of patients with this complication. Pleural effusion, thoracoscopy, surgery