Abstract
Background
Symptomatic pericardial effusion in patients with cancer may lead to a life-threatening event that requires diligent treatment, but the best surgical treatment is still controversial. The purpose of this study was to identify predictors of survival for patients with solid malignancies and symptomatic pericardial effusion, which might help to select the best surgical treatment for each patient.
Methods
We retrospectively analyzed 47 patients with solid malignancies concomitant with symptomatic pericardial effusion who underwent surgery between 1994 and 2004. Overall survival was calculated from date of surgery, and prognostic importance of clinical and pathological variables was assessed.
Results
The most common primary sites of disease were breast (46.8%) and lung (25.6%). Initial pericardiocentesis were performed in 29 patients; median volume of fluid drained was 480 mL. Median interval from the diagnosis of primary cancer to the development of pericardial effusion (pericardial effusion-free interval) was 34.8 months. Definitive surgical treatment was performed in 43 patients, as follows: subxiphoid pericardial window (n = 21); thoracotomy and pleuropericardial window (n = 10); pericardiodesis (n = 8); and videothoracoscopic pleuropericardial window (n = 4). Pericardiocentesis was the only procedure in four patients. Median follow-up was 2.9 months. Median overall survival was 3.7 months. Pericardial effusion-free interval longer than 35 months and more than 480 mL of fluid drained at initial pericardiocentesis were determinants of better survival.
Conclusions
Pericardial window and pericardiodesis seem to be safe and efficacious in treating effusion of the pericardium. Pericardial effusion-free interval and volume drained at initial pericardiocentesis are determinants of outcome.
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References
Bisel H, Wroblewski F, La Due J. Incidence and clinical manifestations of cardiac metastasis. JAMA 1953; 153:712–5
Theologides H. Neoplastic cardiac tamponade. Semin Oncol 1978; 5:181–90
DeCamp MM, Mentzer SJ, Swanson SJ, Sugarbaker DJ. Malignant effusive of the pleura and pericardium. Chest 1997; 112:291S–5S
Vaitkus PT, Herrmann HC, Howard C, Martin L. Treatment of malignant pericardial effusion. JAMA 1994; 272:59–64
Markiewicz W, Borovik R, Ecker S. Cardiac tamponade in medical patients. Am Heart J 1986; 111:1138–42
Little AG, Kremser PC, Wade JL, Levett JM, DeMeester TR, Skinner DB. Operation for diagnosis and treatment of pericardial effusions. Surgery 1984; 96:738–44
Mills SA, Julian S, Holliday RH, et al. Subxiphoid pericardial window for pericardial effusive disease. J Cardiovasc Surg 1989; 30:768–73
Shepherd FA, Morgan C, Evans WK, Ginsberg JF, Watt D, Murphy K. Medical management of malignant pericardial effusion by tetracycline sclerosis. Am J Cardiol 1987; 60:1161–6
Piehler JM, Pluth JR, Schaff HV, Danielson GK, Orszulak TA, Puga FJ. Surgical management of effusive pericardial disease. J Thorac Cardiovasc Surg 1985; 90:506–16
Kaplan EL, Meier P. Non parametric estimation from incomplete observations. J Am Stat Assoc 1958; 53:457–81
Culliane CA, Paz IB, Smith D, Carter N, Grannis FW. Prognostic factors in the surgical management of pericardial effusion in the patient with concurrent malignancy. Chest 2004; 125:1328–34
Girard LN, Ginsberg RJ, Burt ME. Pericardiocentesis and intrapericardial sclerosis: effective therapy for malignant pericardial effusion. Ann Thorac Surg 1997; 64:1422–8
Allen KB, Faber P, Warren WH, Shaar CJ. Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage. Ann Thorac Surg 1999; 69:437–40
Ang P, Tan E, Leong SS, et al. Primary intrathoracic malignant effusion: a descriptive study. Chest 2001; 120:50–4
Park JS, Rentschler R, Wilbur D. Surgical management of pericardial effusion in patients with malignacies: comparison of subxiphoid window versus pericardiectomy. Cancer 1991; 67:76–80
Wang P, Yang K, Chao J, Liu JM, Perng R, Yen S. Prognostic role of pericardial fluid cytology in cardiac tamponade associated with non–small cell lung cancer. Chest 2000; 118:744–9
Cham WC, Freiman AH, Carstens PH, Chu FC. Radiation therapy of cardiac and pericardial metastasis. Radiology 1978; 114:701–4
Spodick D. Current concepts: acute cardiac tamponade. N Engl J Med 2003; 349:684–90
Celermajer D, Boyer M, Bailey B, Fattersall MH. Pericardiocentesis of symptomatic malignant pericardial effusion: a study of 36 patients. Med J Aust 1991; 154:19–22
Lahan RJ, Cohen DJ, Simons M. Pericardial effusion in patients with cancer. J Am Coll Cardiol 1994; 21:275A
Shepherd FA, Ginsberg JS, Evans WK, Scott JG, Oleksiuk F. Tetracycline sclerosis in the management of malignant pericardial effusion. J Clin Oncol 1985; 3:1678–82
Maher EA, Shepherd FA, Todd TJR. Pericardial sclerosis as the primary management of malignant pericardial effusion and cardiac tamponade. J Thorac Cardiovasc Surg 1996; 112:637–43
Yano T, Yokoyama H, Inoue T, Takanashi N, Asoh H, Ichinose Y. A simple technique to manage pericardial effusion with a local instillation of bleomycin in non–small cell carcinoma of the lung. Oncology 1994; 51:507–9
Martinoni A, Cipolla CM, Cardinale D, et al. Long-term results of intrapericardial chemotherapeutic treatment of malignant pericardial effusion with thiotepa. Chest 2004; 126:1412–6
Maisch B, Ristic AD, Pankuweit S, Neubauer A, Moll R. Neoplastic pericardial effusion. Efficacy and safety of intrapericardial treatment with cisplatin. Eur Heart J 2002; 23:1625–31
Ziskind AA, Pearce AC, Lemon CC, et al. Percutaneous balloon pericardiotomy for the treatment of cardiac tamponade and large pericardial effusions: description of technique and report of the first 50 cases. J Am Coll Cardiol 1993; 21:1–5
Marcy PY, Bandiau PY, Brunner P. Percutaneous treatment in patients presenting with malignant cardiac tamponade. Eur Radiol 2005; 15(9):2000--20009
Haddad FJ, Younes RN, Gross JL, Deheinzelin D. Pleurodesis in patients with malignant pleural effusion: talc slurry or bleomycin? Results of a prospective randomized trial. World J Surg 2004; 28:749–54
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Gross, J.L., Younes, R.N., Deheinzelin, D. et al. Surgical Management of Symptomatic Pericardial Effusion in Patients with Solid Malignancies. Ann Surg Oncol 13, 1732–1738 (2006). https://doi.org/10.1245/s10434-006-9073-1
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DOI: https://doi.org/10.1245/s10434-006-9073-1