INDWELLING CATHETER FOR MALIGNANT PLEURAL EFFUSION: SUBCUTANEOUS IS BETTER?

Abstract

TOPIC: Disorders of the Pleura TYPE: Original Investigations PURPOSE: In the management of malignant pleural effusion (MPE), the only option for symptoms control in case of trapped lung or symptomatic recurrence after talc pleurodesis is the positioning of a long-term indwelling pleural catheter. The inconvenient of such a solution is that a part of the tube remains outside the skin. A technical alternative is represented by a totally implantable device in which the chest tube is connected to a subcutaneous reservoir allowing aspiration by a simple cutaneous puncture. This study present early results from a series of patients with MPE in which this device was implanted. METHODS: Since April 2019, at the Thoracic Surgery Department of S. Luigi Hospital, Orbassano, Italy, a totally implantable indwelling catheter (Celsite Drainaport, Braun, Berlin) was implanted in all patients with MPE associated with trapped lung or recurrence after surgical pleurodesis. Patients data was obtained by the institutional research database (Architor) and analysed in terms of: 1) symptoms control (defined as ineffective when additional pleural procedures were required after catheter positioning), 2) device malfunction, 3) local infection, 4) feasibility of systemic treatment after the procedure, and 5) management of fluid removal (homecare Vs hospital). RESULTS: In the period April 2019-March 2021, a Pleural Port was implanted in 40 consecutive patients (median age 73 years, 21 men). MPE was due to lung cancer in 21 cases, mesothelioma in 7, other tumors in 22. Indication was presence of a trapped lung in 23 patients and recurrence in 17 patients. Effective symptom control was obtained in 39 cases (97%). In one patient (2.5%) in poor general condition multiple thoracentesis were required due to device malfunction. No sign of local infection was detected in any patient. After the procedure, 17 cases (42%) started a systemic treatment and 16 cases (40%) required exclusive home palliative care. At follow-up on April 2021, 36 deaths were recorded due to tumor progression with a median survival time of 74,5 days. CONCLUSIONS: The use of a totally implantable system is an effective palliative treatment in MPE associated with trapped lung or recurrence after surgical pleurodesis. The absence of potential contamination due to a totally subcutaneous device seems to reduce the risk of local infection but this advantage has to be confirmed in the context of a randomized trial. CLINICAL IMPLICATIONS: In complex MPE, the use of a totally implantable pleural system represents an additional option allowing an effective symptoms control without the risk of local complications. DISCLOSURES: No relevant relationships by Marco Donatello Delcuratolo, source=Web Response No relevant relationships by Luca Errico, source=Web Response No relevant relationships by Stefano Ganio, source=Web Response No relevant relationships by Francesco Leo, source=Web Response No relevant relationships by Federica Mellone, source=Web Response No relevant relationships by Alberto Sandri, source=Web Response No relevant relationships by Federico Vaisitti, source=Web Response