Malignant pleural effusions and trapped lung

Abstract

: Malignant pleural effusions (MPEs) are of great importance for the prognosis of patients with oncological diseases. The current review focuses on the problem of the management of patients with MPEs complicated with trapped lung, which is still a subject of discussion. “Trapped lung” describes the situation in advanced malignant pleural disease in which the lung is unable to fully expand to fill the hemithorax, rendering the parietal and visceral pleura either partly or completely unopposed, with the presence of a residual cavity. A variety of diagnostic approach for the condition of a trapped lung (imaging or invasive) are analyzed. Nowadays the optimal approach to MPE with a trapped lung is still a subject of discussion. In general, the management is a challenge for the thoracic surgeon and medical oncologists and focuses on palliative relieving of the symptoms and reduction of the hospitalization rates rather than on cure, because of the end-stage of the neoplastic disease Different strategies for palliative treatment are debated, including placement of indwelling pleural catheters, surgical decortications (open thoracotomy or closed VATS), pleuroperitoneal shunts and intra-pleural fibrinolytic therapy. The last two are not routinely applicable. Any planned treatment should balance the therapeutic benefit provided against the required period of convalescence for a disease with a limited life expectancy. Randomized controlled multicenter clinical trials in patients with comparable diseases and comorbidity are needed to clarify which is the most appropriate treatment modality. To the present date, VATS decortication seems to be an excellent therapeutic method offering as large as possible macroscopic reduction of the tumor and re-expansion of the lung in surgically fit patients. VATS has a significantly less operative risk than radical invasive surgical interventions, minimizes the surgical trauma and pain, shortens the postoperative in-hospital stay, resulting respectively in susceptible Quality of Life improvement.