Video-assisted thoracoscopic pleuro-pericardial window for recurrent massive pericardial effusion in patients with known malignancy

Abstract

BackgroundMultiple treatment options for pericardial effusion are present including medical treatment, needle pericardiocentesis, percutaneous catheter drainage, and surgical drainage. Surgical intervention includes subxiphoid drainage and pleuro-pericardial window. This study focuses on video-assisted thoracoscopic surgery as a treatment option for recurrent massive malignant pericardial effusion. MethodsThis was a prospective study carried out at Menoufia Faculty of Medicine University Hospital. It included 20 patients with a known history of malignancy and an echocardiographic evidence of massive recurrent pericardial effusion. We used video-assisted thoracoscopy to create a large window in the pericardium to the pleura. ResultsThis study included 20 patients with a mean age of 45 years. The primary malignancy was breast cancer in 11 cases (55%), lung cancer in 4 cases (20%), lymphoma in 3 cases (15%), leukemia in 1 case, and cancer cervix in 1 case. The operative time ranged from 40 to 75 min. Postoperative complications occurred in 2 cases (10%). The chest tube duration ranged from 2 to 7 days, and the mean postoperative hospital stay was 4.6 ± 1.8 days. Histopathology of the pericardial specimen was positive for malignancy in 11 cases (55%) and revealed non-specific pericarditis in 9 cases (45%). We did not record postoperative mortality, but at 3 months postoperatively, 3 patients were dead due to progression of their primary malignancy, and one patient developed recurrence. ConclusionWe concluded that thoracoscopic pleuropericardial window is an excellent treatment option for recurrent massive malignant pericardial effusion in patient who could tolerate the procedure.