Annals of Surgical Oncology

, Volume 18, Issue 4, pp 1145–1150 | Cite as

Is Silver Nitrate Pleurodesis for Patients with Malignant Pleural Effusion Feasible and Safe When Performed in an Outpatient Setting?

  • Ricardo Mingarini Terra
  • So Yeon Kim
  • Paulo Manuel Pego-Fernandes
  • Lisete Ribeiro Teixeira
  • Francisco Suso Vargas
  • Fabio Biscegli Jatene
Thoracic Oncology

Abstract

Background

The purpose of this study was to analyze the effectiveness and safety of silver nitrate pleurodesis (SNP) in patients with recurrent malignant pleural effusion (RMPE) when performed in an outpatient setting.

Materials and Methods

Prospective study including patients with RMPE recruited in a tertiary university-based hospital from February 2008 to June 2009. Elected patients underwent pleural catheter insertion (Day 1) followed by 0.5% SNP (Day 2), and on 7th day the drain was removed. All procedures were performed in an outpatient facility. Pleurodesis was considered successful when no additional pleural procedure was necessary by the 30th day. Complications were registered and graded according to the CTCAE3.0. Quality of life was evaluated before and 30 days after SNP.

Results

A total of 68 patients (54 female, 14 male, mean age: 57.3 years) were included. In addition, 7 had bilateral pleural effusions; therefore, 75 hemithoraces were drained. Also, 5 were excluded, and 70 hemithoraces (63 patients) underwent SNP. During the period of 30 days postpleurodesis, 8 deaths not related to the procedure occurred, and we lost contact with 10 patients who were followed elsewhere. At the 30th day, 48 hemithoraces (45 patients) were reevaluated, and 2 recurrences observed. The most frequent complication was pain—graded as 3 or more in 7 patients; infection occurred in 2 patients. Physical and environmental aspects of quality of life improved significantly after pleurodesis.

Conclusions

In this study, SNP could be performed safely in an outpatient setting, with pain the most frequent complication. Recurrences occurred in 4% of the patients.

References

  1. 1.
    Lynch TJ Jr. Management of malignant pleural effusions. Chest. 1993;103:385S–9S.PubMedGoogle Scholar
  2. 2.
    Neto JD, de Oliveira SF, Vianna SP, Terra RM. Efficacy and safety of iodopovidone pleurodesis in malignant pleural effusions. Respirology. 2010;15:115–8.PubMedCrossRefGoogle Scholar
  3. 3.
    de Campos JR, Vargas FS, de Campos Werebe E, Cardoso P, Teixeira LR, Jatene FB, et al. Thoracoscopy talc poudrage: a 15-year experience. Chest. 2001;119:801–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med. 1994;120:56–64.PubMedGoogle Scholar
  5. 5.
    Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions (Cochrane Review). In: The Cochrane Library. Issue 4, 2004. Oxford: Updated Software.Google Scholar
  6. 6.
    Kennedy L, Rusch VW, Strange C, Ginsberg RJ, Sahn SA. Pleurodesis using talc slurry. Chest. 1994;106:342–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Werebe EC, Pazetti R, Milanez de Campos JR, Fernandez PP, Capelozzi VL, Jatene FB, Vargas FS. Systemic distribution of talc after intrapleural administration in rats. Chest. 1999;115:190–93.PubMedCrossRefGoogle Scholar
  8. 8.
    de Campos JR, Werebe EC, Vargas FS, Jatene FB, Light RW. Respiratory failure due to insufflated talc. Lancet. 1997;349:251.PubMedCrossRefGoogle Scholar
  9. 9.
    Rehse DH, Aye RW, Florence MG. Respiratory failure after talc pleurodesis. Am J Surg. 1999;177:437–40.PubMedCrossRefGoogle Scholar
  10. 10.
    Janssen JP, Collier G, Astoul P, Tassi GF, Noppen M, Rodriguez-Panadero F, et al. Safety of pleurodesis with talc poudrage in malignant pleural effusion: a prospective cohort study. Lancet. 2007;369:1535–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Genofre EH, Vargas FS, Acencio MM, Antonangelo L, Teixeira LR, Marchi E. Talc pleurodesis: evidence of systemic inflammatory response to small size talc particles. Respir Med. 2009;103:91–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Maskell NA, Lee YC, Gleeson FV, Hedley EL, Pengelly G, Davies RJ. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med. 2004;170:377–82.PubMedCrossRefGoogle Scholar
  13. 13.
    Ferrer J, Montes JF, Villarino MA, Light RW, Garcia-Valero J. Influence of particle size on extrapleural talc dissemination after talc slurry pleurodesis. Chest. 2002;122:1018–27.PubMedCrossRefGoogle Scholar
  14. 14.
    Paschoalini M da S, Vargas FS, Marchi E, Pereira JR, Jatene FB, Antonangelo L, et al. Prospective randomized trial of silver nitrate vs talc slurry in pleurodesis for symptomatic malignant pleural effusions. Chest. 2005;128:684–9.CrossRefGoogle Scholar
  15. 15.
    Vargas FS, Teixeira LR, Vaz MA, Carmo AO, Marchi E, Cury PM, et al. Silver nitrate is superior to talc slurry in producing pleurodesis in rabbits. Chest. 2000;118:808–13.PubMedCrossRefGoogle Scholar
  16. 16.
    Saffran L, Ost DE, Fein AM, Schiff MJ. Outpatient pleurodesis of malignant pleural effusions using a small-bore pigtail catheter. Chest. 2000;118:417–21.PubMedCrossRefGoogle Scholar
  17. 17.
    Spiegler PA, Hurewitz AN, Groth ML. Rapid pleurodesis for malignant pleural effusions. Chest. 2003;123:1895–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0, DCTD, NCI, NIH, DHHS, March 31, 2003 (http://ctep.cancer.gov), Publish Date: August 9, 2006.
  19. 19.
    The WHOQoL Group. The development of the World Health Organization quality of life assessment instrument (the WHOQoL). In: Orley J, Kuyken W, eds. Quality of Life Assessment: International Perspectives. Heidelberg: Springer Verlag, 1994.Google Scholar
  20. 20.
    Fleck MPA, Leal OF, Louzada S, Xavier M, Chachamovich E, Vieira G, et al. Desenvolvimento da versão em português do instrumento de avaliação de qualidade de vida da OMS (WHOQoL-100) 1999. Rev Bras Psiquiatr. 1999;21:19–28.CrossRefGoogle Scholar
  21. 21.
    Wied U, Andersen K, Schultz A, Rasmussen E, Watt-Boolsen S. Silver nitrate pleurodesis in spontaneous pneumothorax. Scand J Thorac Cardiovasc Surg. 1981;15:305–7.PubMedGoogle Scholar
  22. 22.
    Wied U, Halkier E, Hoeier-Madsen K, Plucnar B, Rasmussen E, Sparup J. Tetracycline versus silver nitrate pleurodesis in spontaneous pneumothorax. J Thorac Cardiovasc Surg. 1983;86:591–3.PubMedGoogle Scholar
  23. 23.
    Vargas FS, Teixeira LR, Silva LM, Carmo AO, Light RW. Comparison of silver nitrate and tetracycline as pleural sclerosing agents in rabbits. Chest. 1995;108:1080–3.PubMedCrossRefGoogle Scholar
  24. 24.
    Vargas FS, Antonangelo L, Capelozzi V, Vaz MA, Genofre EH, Marchi E, et al. Lung damage in experimental pleurodesis induced by silver nitrate or talc: 1-year follow-up. Chest. 2002;122:2122–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Terra RM, Teixeira LR, Bibas BJ, Pego-Fernandes PM, Vargas FS, Jatene FB. Effectiveness and safety of outpatient pleurodesis in patients with recurrent malignant pleural effusion and low performance status. Clinics. 2011 [Epub ahead of print].Google Scholar
  26. 26.
    Tremblay A, Michaud G. Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion. Chest. 2006;129:362–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Warren WH, Kim AW, Liptay MJ. Identification of clinical factors predicting Pleurx catheter removal in patients treated for malignant pleural effusion. Eur J Cardiothorac Surg. 2008;33:89–94.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Ricardo Mingarini Terra
    • 1
  • So Yeon Kim
    • 2
  • Paulo Manuel Pego-Fernandes
    • 1
  • Lisete Ribeiro Teixeira
    • 3
  • Francisco Suso Vargas
    • 3
  • Fabio Biscegli Jatene
    • 1
  1. 1.Thoracic Surgery DivisionHospital das Clínicas, University of São Paulo Medical SchoolSão PauloBrazil
  2. 2.University of São Paulo Medical SchoolSão PauloBrazil
  3. 3.Pulmonology DivisionHospital das Clínicas, University of São Paulo Medical SchoolSão PauloBrazil

Personalised recommendations