P02.16 Rigid Medical Thoracoscopy in a Large UK District General Hospital

Abstract

Medical thoracoscopy (MT) is a well established diagnostic and theurapeutic intervention for malignant as well as benign pleural effusions. National guidelines were established in 2010 and standards set for diagnostic sensitivity and pleurodesis rates. We report ourexperience in a district general hospital. We performed a retrospective analysis of 296 patients having MT between January 2010 and October 2019. Basic demographics were collected alongside procedural and post procedural complications. Biopsy findings were analysed and completed follow up of any patients described. Descriptive statistics were used to summarize the data. Locally, MT is performed in theatre, under conscious sedation and pre-operative prophylactic antibiotics are given. We use a rigid thoracoscope. 78.5% of the patients were male, median age being 72yrs. Diagnoses were malignant mesothelioma (124), lung cancer (35), breast cancer (17), empyema (7), chronic inflammation/pleuritis (83), other diagnoses such as melanoma, lymphomas, thymomas and aytpical proliferative processes (30). Histological confirmation by MT was 97% sensitive, above averages. 5 patients with atypia on histology had a cancer diagnosis via either surgical or image guided biopsies. 2 patients with pleuritis on histology had clinical evidence of cancer but were not investigated further. Complications included pleural infection [5(1.6%)], wound infection [4(1.4%)], air leaks more than 5 days [9(3%)], surgical emphysema [n=10(3.3%)], death due to procedure within 30 days [n=1(0.3%)] and tumour extension [n=1(0%)]. There was 1 displaced drain, 1 skin reaction secondary to the dressing and 1 wound leak requiring re-suturing in theatre. Median length of stay was 3.96 days (national average 4.6). The death was due to pre-op antibiotic induced acute kidney injury;local policy has changed since then. Pleurodesis was performed in 166 patients, and successful in 86%, in the absence of trapped lung (national average 80%); success being defined by patients not requiring another procedure within 30 days. 78(28%) patients had trapped lung, reflecting higher incidence of mesothelioma and 27 of those had a repeat procedure. 6 patients have had a simultaneous indwelling pleural catheter at the time of thoracoscopy and discharged the same day. MT is a safe and effective procedure. Our higher diagnostic sensitivity and lower complication rates are probably down to 3 experienced practitioners, prophylactic antibiotics and using a rigid thoracoscope. We are actively trying to reduce our length of stay by practising day case thoracoscopy with the simultaneous insertion of an indwelling pleural catheter. We follow all patients with chronic fibrinous pleuritis over 2 years and 12 patients have currently not completed this follow up period.