Fibrin Pleurodesis for Palliative Treatment of the Malignant Pleural Effusion

Abstract

Fibrin pleurodesis is a palliative therapy for recurrent malignant pleural effusions. It represents an alternative to other pleurodesis treatments, which often are painful (tetracycline, cytostatics). Between 1988 and 1992 we performed 41 fibrin pleurodeses in malignant pleural effusions. The procedure was as follows. All fluid was removed from the thoracic cavity by suction drainage as described by Matthys. After 24-h the drainage was repeated. In this way the amount of fluid effused in 24 h was determined. Then 4 × 2 ml fibrin sealant (Tissucol Duo S) was administered via the same catheter, but after every 2 ml the procedure was interrupted to change the patient’s position. Pleurodesis was considered a success if within 30 days postoperatively no recurrence of the effusion was observed. A minor effusion that did not require drainage was listed as a partial success. If another aspiration of fluid was necessary within 30 days, the case was regarded to be a failure. In 22 cases pleurodesis proved successful, in 12 we scored a partial success, and in 7 pleurodesis failed to control pleural effusion. In 21 of 24 patients in whom the quantity of fluid effused in 24 h was smaller than 200 ml pleurodesis was a success, in two a partial success, and in one a failure. Of 17 patients with an effusion volume exceeding 200 ml pleurodesis was successful in only one and a partial success in ten whereas 7 cases were failures. No side effects were observed during or after the application of fibrin sealant. In respect of success and partial success of fibrin pleurodesis, the success rate (77.3%) is comparable to other pleurodesis procedures. The volume of pleural effusion within 24 h is a good prognostic parameter of success or failure of any pleurodesis (at an effusion volume of less than 200 ml the success rate is 95.8%). In comparison with other pleurodesis methods, fibrin sealing has almost no side effects; moreover, it is painless for the patient.