Medical thoracoscopy for the management of pleural effusion. A thoracic surgeon's experience

Postgraduate Thesis uoadl:1314997 1064 Read counter

Unit:
Κατεύθυνση Καρκίνος Πνεύμονα: Σύγχρονη Κλινικοεργαστηριακή Προσέγγιση και Έρευνα
Library of the School of Health Sciences
Deposit date:
2016-04-01
Year:
2016
Author:
Καπετανάκης Εμμανουήλ
Supervisors info:
Κωνσταντίνος Συρίγος, Περικλής Τόμος, Κωνσταντίνος Πόταρης
Original Title:
Medical thoracoscopy for the management of pleural effusion. A thoracic surgeon's experience
Languages:
English
Translated title:
Η ιατρική θωρακοσκόπηση στήν αντιμετώπιση της πλευριτικής συλλογής. Ο ρόλος του θωρακοχειρουργού.
Summary:
Introduction: Medical thoracoscopy is a minimally invasive procedure utilized
mainly by pulmonologists for the diagnosis and management of pleural effusions.
The main indications for performing it includes the diagnosis of pleural
effusions of unknown origin, the diagnosis, staging and management of
established malignant pleural effusions and the drainage of infected
parapneumonic effusions and empyema. The aim of this study was to evaluate the
efficacy and safety of medical thoracoscopy when performed by a combined team
of pulmonologists and thoracic surgeons in a tertiary level university hospital.

Methods: This is a retrospective cohort analysis of all patients with pleural
effusion which underwent medical thoracoscopy at the General Hospital of Athens
“Laiko” over a period of nineteen (19) months from June 2013 up to December
2014.

Results: Thirty six (36) patients presenting with pleural effusion underwent
medical thoracoscopy. Of those 18 (50%) were male and 18 (50%) were female. The
average patient age was 61 years. Twenty-six (72%) patients presented with an
undiagnosed pleural effusion, six (17%) with known malignant, recurrent pleural
effusion, three (8%) with parapneumonic effusion/empyema and one (3%) with an
idiopathic pleural effusion due to nephritic syndrome, Eighteen (50%) patients
underwent drainage and pleural biopsy, 9 (25%) patients underwent drainage,
pleural biopsy and talc pleurodesis, 6 (17%) underwent only drainage and talc
pleurodesis due to known malignant pleural effusion and 3 (8%) underwent only
drainage of their parapneumonic effusion/empyema. Of the 27 patients which
underwent diagnostic pleural biopsy 15 (55%) demonstrated neoplastic disease [2
(7%) had primary lung cancer, 4 (15%) had mesothelioma, 3 (11%) had metastatic
disease of non thoracic primary origin and 3 (11%) had lymphoma] while 8 (30%)
patients had non malignant, mainly autoimmune or inflammatory, causes of their
effusions [1 (4%) had tuberculosis, 4 (15%) had systemic lupus eryhtematosus, 1
(4%) showed chronic inflammation, 1 (4%) had chronic pleural fibrosis and 1
(4%) had nephritic syndrome]. In 3 (11%) patients the biopsy was negative and
only in one (4%) patient medical thoracoscopy failed to provide a diagnosis
giving us a diagnostic sensitivity for our series of 96%. Post procedural
complications were mild with 6 (17%) patients developing subcutaneous
emphysema, 3 (8%) cases demonstrated minor bleeding and only one (3%) patient
developed a subsequent empyema, systemic sepsis and died.

Conclusion: Medical thoracoscopy when performed by a combined team of
pulmonologists and thoracic surgeons in a tertiary level hospital is a quite
safe and efficacious technique for the diagnosis and management of pleural
effusion in patients unable to undergo or not requiring surgical intervention.
Consequently, a thoracic surgeon can play quite a significant leadership and
educational role in a medical thoracoscopy service.
Keywords:
Medical Thoracoscopy, Pleural effusion, Pleural biopsy, Pleurodesis, Empyema
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
68
Number of pages:
83
File:
File access is restricted only to the intranet of UoA.

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