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

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgement

Dr. Ricardo participated in study design, data collection, data analysis, and manuscript writing and revision. So Yeon Kim participated in data collection, data analysis, and manuscript writing. Dr. Paulo participated in study design, data analysis, and manuscript revision. Dr. Lisete participated in study design, patient recruitment, and manuscript revision. Dr. Francisco participated in data analysis, manuscript writing, and revision. Dr. Fabio participated in study design, data analysis, and manuscript revision. So Yeon Kim received a year-long scholarship from FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo), a state-affiliated foundation that supports and finances scientific projects (process number: 2009/50894-2). So Yeon Kim has received a scholarship from FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo) during the period of 12 months.

Conflict of interest

None.

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Authors and Affiliations

  1. Thoracic Surgery Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil

    Ricardo Mingarini Terra MD, PhD, Paulo Manuel Pego-Fernandes MD, PhD & Fabio Biscegli Jatene MD, PhD

  2. University of São Paulo Medical School, São Paulo, Brazil

    So Yeon Kim

  3. Pulmonology Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil

    Lisete Ribeiro Teixeira MD, PhD & Francisco Suso Vargas MD, PhD

Authors
  1. Ricardo Mingarini Terra MD, PhD
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  2. So Yeon Kim
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  3. Paulo Manuel Pego-Fernandes MD, PhD
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  4. Lisete Ribeiro Teixeira MD, PhD
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  5. Francisco Suso Vargas MD, PhD
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  6. Fabio Biscegli Jatene MD, PhD
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Corresponding author

Correspondence to Ricardo Mingarini Terra MD, PhD.

Additional information

This study was performed at the Thoracic Surgery and Pulmonology Divisions of the Heart Institute (InCor) Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.

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Terra, R.M., Kim, S.Y., Pego-Fernandes, P.M. et al. Is Silver Nitrate Pleurodesis for Patients with Malignant Pleural Effusion Feasible and Safe When Performed in an Outpatient Setting?. Ann Surg Oncol 18, 1145–1150 (2011). https://doi.org/10.1245/s10434-010-1447-8

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  • DOI: https://doi.org/10.1245/s10434-010-1447-8

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