ABSTRACT
BACKGROUND: Malignant pleural effusion (MPE) complicates many neoplasms and its incidence is expected to rise in parallel with the aging population and longer survival of cancer patients. Although a clear consensus exists on indwelling catheters in patients with poor performance status, no study has hitherto compared different devices in patients requiring temporary or definitive drainage following talc poudrage. METHODS: This is a prospective, two-arm, pilot study on patients with MPE undergoing talc poudrage, comparing two different catheters (PleurX® versus Pleurocath®) positioned because of the inefficacy of the procedure or the high risk of short-term failure. End points of the study were quality of life (QoL), median dyspnea and chest pain assessment by EORTC questionnaires and a 100 mm visual analog scale, total in-hospital length of stay and frequency of serious adverse events. RESULTS: No difference was observed between the two groups in in mean dyspnea and mean chest pain in any questions of the EORTC QLQ-C30 and QLQ-LC13 questionnaires. Duration of the procedure was significantly longer in the PleurX® group versus the Pleurocath® group (72±33 versus 44±13 minutes; P=0.03). No difference was observed between the two groups in total length of hospital stay (P=1.00) or complication rate (P=1.00). CONCLUSIONS: For the cohort of patients still needing indwelling pleural catheters (PC) after thoracoscopic talc poudrage, PleurX® is suggested when drain removal is unlikely due to short life expectancy or the high chance of pleurodesis failure. Conversely, Pleurocath® should be recommended in all other patients as it is faster to place and easier to remove. KEYWORDS: Malignant pleural effusion (MPE); talc poudrage; indwelling pleural catheter (indwelling PC).
ABSTRACT
El tratamiento paliativo de la estenosis traqueobronquial maligna es difícil. Las experiencias publicadas con stent en Y autoexpandibles son escasas, por lo que es necesario evaluar si los resultados que ofrecen son mejores que los de otras prótesis alternativas. Presentamos una serie retrospectiva de 20 pacientes consecutivos con estenosis traqueobronquial maligna, a los que se insertó un stent en Y metálico y recubierto. Las variables analizadas fueron las siguientes: alivio de la disnea, complicaciones y supervivencia. Los stent se insertaron a través de un traqueoscopio rígido en las 24h siguientes al ingreso del paciente, de forma segura y sin dificultades. Todos los pacientes lograron un alivio eficaz de la disnea y no se observaron efectos adversos, tempranos o tardíos, relacionados con el stent. La mortalidad a los 30 días fue del 40%, con una mediana de supervivencia de 12,2 semanas. La inserción de stent en Y autoexpandibles es un procedimiento seguro y eficaz para el tratamiento paliativo de la estenosis traqueobronquial maligna. En la actualidad, este es nuestro stent de elección para este subgrupo de pacientes
Palliation of malignant tracheobronchial stenosis is challenging. Published experience with self-expanding Y-shaped stents is limited and it seems necessary to evaluate whether they improve clinical results with respect to alternative prostheses. We present a retrospective case series of 20 consecutive patients with malignant tracheobronchial stenosis that underwent placement of a single-unit, Y-shaped covered metallic stent. Outcomes were: safety of the procedure, palliation of dyspnea, complications, and survival. All stents were safely and easily placed using a rigid tracheoscope within 24hours of admission. Dyspnea was effectively palliated in all patients, and no early or late adverse stent-related events were observed. Thirty-day mortality was 40%. Median survival was 12.2 weeks. Placement of Y-shaped self-expanding stents is a safe and effective procedure for the palliation of malignant tracheobronchial stenosis, and is currently our stent of choice for this subgroup of patients
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Tracheal Stenosis/surgery , Stents , Dyspnea/surgery , Airway Obstruction/surgery , Retrospective Studies , Palliative Care/methods , EndoscopyABSTRACT
Palliation of malignant tracheobronchial stenosis is challenging. Published experience with self-expanding Y-shaped stents is limited and it seems necessary to evaluate whether they improve clinical results with respect to alternative prostheses. We present a retrospective case series of 20 consecutive patients with malignant tracheobronchial stenosis that underwent placement of a single-unit, Y-shaped covered metallic stent. Outcomes were: safety of the procedure, palliation of dyspnea, complications, and survival. All stents were safely and easily placed using a rigid tracheoscope within 24hours of admission. Dyspnea was effectively palliated in all patients, and no early or late adverse stent-related events were observed. Thirty-day mortality was 40%. Median survival was 12.2 weeks. Placement of Y-shaped self-expanding stents is a safe and effective procedure for the palliation of malignant tracheobronchial stenosis, and is currently our stent of choice for this subgroup of patients.
Subject(s)
Airway Obstruction/therapy , Bronchial Diseases/therapy , Bronchial Neoplasms/secondary , Carcinoma/complications , Stents , Tracheal Neoplasms/secondary , Tracheal Stenosis/therapy , Aged , Aged, 80 and over , Airway Obstruction/etiology , Airway Obstruction/surgery , Bronchial Diseases/etiology , Bronchial Diseases/surgery , Bronchial Neoplasms/complications , Bronchoscopy , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Constriction, Pathologic/therapy , Equipment Design , Female , Humans , Laser Therapy , Male , Middle Aged , Palliative Care/methods , Radiography, Interventional , Retrospective Studies , Tracheal Neoplasms/complications , Tracheal Stenosis/etiology , Tracheal Stenosis/surgeryABSTRACT
We report a case of a 54-year-old Caucasian male with exertional dyspnea who underwent palliative resection of a solitary right ventricular metastasis one year after liver transplant for a multifocal HBV-related hepatocellular carcinoma (HCC). After nine months the patient remains asymptomatic and cardiac MRI shows no local progression of the tumor.
Subject(s)
Carcinoma, Hepatocellular/secondary , Carcinoma, Hepatocellular/surgery , Heart Neoplasms/secondary , Heart Neoplasms/surgery , Heart Ventricles , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Carcinoma, Hepatocellular/etiology , Cardiac Surgical Procedures/methods , Heart Neoplasms/pathology , Hepatitis B/complications , Humans , Liver Neoplasms/etiology , Liver Transplantation , Magnetic Resonance Imaging , Male , Middle Aged , Palliative Care/methods , Treatment OutcomeABSTRACT
We report a case of locally advanced excavated non-small cell lung cancer with superior vena cava (SVC) syndrome that underwent four cycles of induction chemotherapy. Due to early treatment failure and the impossibility applying radical radiotherapy, a decision was made to perform surgery. The patient underwent right intrapericardial pneumonectomy with en-bloc resection of the SVC, azygos vein and mediastinal lymph nodes. Prosthetic azygo-atrial bypass was then performed. The patient enjoys one year progression-free survival with patent graft and symptomatic relief of SVC syndrome.
Subject(s)
Azygos Vein/surgery , Blood Vessel Prosthesis Implantation/methods , Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/surgery , Superior Vena Cava Syndrome/surgery , Azygos Vein/diagnostic imaging , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Follow-Up Studies , Heart Atria/surgery , Humans , Lung Neoplasms/diagnostic imaging , Male , Middle Aged , Palliative Care/methods , Superior Vena Cava Syndrome/diagnostic imaging , Tomography, X-Ray ComputedSubject(s)
Lung Neoplasms/surgery , Pneumonectomy , Pulmonary Artery/surgery , Surgical Stapling , Thoracotomy/methods , Female , Humans , MaleABSTRACT
We report a case of successful salvage surgery for invasive thymoma initially judged to be unresectable that did not respond to sequential chemoradiotherapy. The patient underwent en bloc resection of the tumor, superior vena cava, upper portion of the right atrium (RA) and intracardiac neoplastic thrombus with the aid of a cardiopulmonary bypass without cardiac arrest. The patient is disease free 8.5 years after radical thymectomy and subsequent resection of 2 second primary lung adenocarcinomas.
