Home-management of malignant pleural effusion with an indwelling pleural catheter: Ten years experience

Background: More than one half of patients with cancer have a malignant pleural effusion (MPE) at some time during their life span. Re- current malignant pleural effusions impair respiratory functions and worsen the quality of life. Once a patient develops MPE, only fluid drainage relieves pulmonary compression and dyspnea. Optimal treatment is however, still controversial. In patients not suitable for pleu- rodesis, or with recurrent MPE after pleurodesis, or with trapped lung, the outpatient intermittent drainage through a subcutaneous tunneled indwelling pleural catheter (IPC) is a possible choice. Methods: In ten years, we treated 90 patients by outpatient insertion of IPC. Eligibility for IPC required previous thoracentesis with his- tological confirmation of malignancy and chest roentgenogram evidence of effusion. All patients treated were made aware of their malig- nancy and positive cytology in the pleural effusion. Results: Mean survival was 197 days (range 23e296 days). Median time of draining interval was 7.0 days with maximum amount of ef- fusion drained off being 1000 ml. Pleurodesis occurred in 37 (41.1%) patients with a mean time of pleurodesis of 51 days (range 34e78 days). No major complication was recorded. Conclusions: The IPC is a useful device in the management of recurrent MPE. Treatment can be entirely accomplished at home and the complication rate is low.