Pleurodesis

Pleural effusion is a common symptom of malignant pleural mesothelioma, caused by fluid buildup between layers of the pleura. This can cause an array of bothersome symptoms, causing patients to seek treatment. Pleurodesis is a palliative treatment used to treat pleural effusion, and often a common component of malignant mesothelioma treatment plans.

Pleurodesis and Pleural Effusion

The pleura, or linings of the lungs, form an inner and outer layer. Pleural mesothelioma causes excess fluid to build up in the pleural cavity, known as pleural effusion. Sometimes a symptom of other diseases like lung cancer, pleural effusion is often an indicator of mesothelioma, especially for patients with a history of asbestos exposure. Pleural effusion puts pressure on the lungs and causes the following symptoms:

• Shortness of breath
• Difficulty breathing
• Irregular heartbeat
• Dry cough
• Chest pain

Pleurodesis is a surgical procedure that removes this excess fluid and attempts to prevent it from coming back, therefore helping to improve breathing and alleviate other symptoms. As a palliative procedure, pleurodesis does not improve survival rate and is solely meant to improve quality of life.

Pleurodesis Procedure

After pleural mesothelioma patients present symptoms to their physician, imaging tests are often done; pleural effusion can be seen on scans such as a chest X-ray or CT scan. When an effusion is detected and symptoms have escalated to a point of causing shortness of breath, mesothelioma specialists may recommend a pleurodesis. If the patient is in the late stages of their mesothelioma diagnosis, patients may not qualify.

There are different types of pleurodesis, including chemical pleurodesis, mechanical pleurodesis (otherwise known as surgical pleurodesis) and rapid pleurodesis.

Chemical Pleurodesis

After anesthesia administration, a needle is inserted into the chest, using a drainage tube to drain pleural fluid. After drainage, a treatment agent is inserted between the lung and chest wall, typically talc, Bleomycin, Tetracycline or Doxycycline. The entire process may take a couple of hours, and pain medication is usually given to combat any pain and discomfort. Less invasive than other forms of pleurodesis procedures and often less expensive, chemical pleurodesis is common. Chemical pleurodesis can be performed with video-assisted thoracic surgery (VATS) as well, which may be an option if a surgical biopsy is needed and/or the patient cannot tolerate the pain of “bedside” chemical pleurodesis.

Mechanical or Surgical Pleurodesis

Every case of malignant mesothelioma is different; in some cases, surgeons may perform a mechanical pleurodesis. Instead of using a chemical, mechanical pleurodesis is a procedure that uses gauze, a rough pad or other abrasive surfaces to cause irritation/inflammation and seal the pleural space closed. Mechanical pleurodesis requires VATS or thoracotomy in order to perform it. Mechanical pleurodesis can be combined with chemical pleurodesis in the same sitting.

Pleurodesis via Indwelling Pleural Catheter

Chemical or mechanical pleurodesis typically requires the patient to stay a few days in the hospital. In an effort to reduce a patient’s inpatient stay, physicians may recommend placement of an indwelling pleural catheter. This is a catheter that is tunneled under the skin and that the patient goes home with. At home, the patient and/or their family will drain the chest cavity intermittently by attaching a suction bulb or other device to the catheter. This can be done daily, or less frequently, as required. Eventually, keeping the chest cavity well-drained often leads to pleurodesis. At that point, the catheter may be removed in a simple procedure in the office or operating room.

One study that analyzed the hospital stay difference between chemical and rapid pleurodesis procedures found a median hospital stay of 10 days for those using solely chemical, and 2 for those utilizing a catheter through a rapid procedure. The advantage of this procedure is that the patient may be able to be discharged from the hospital sooner; the disadvantage is that the patient has a manmade object implanted that requires care and can become infected or clogged.

After undergoing a pleurodesis, patients may face side effects like fever, pain or soreness. Doctors may provide pain medication, but anti-inflammatory drugs, such as Ibuprofen, are avoided as they may interfere with fusion of the pleural layers.

Risks and Benefits of Pleurodesis

As with any mesothelioma surgery, pleurodesis has risks and potential complications that must be addressed prior to surgery, especially for patients of poor health. However, the surgery can also offer many benefits to patients suffering from mesothelioma symptoms.

Pleurodesis palliative care isn’t a treatment option for all mesothelioma patients and must be discussed with their medical care team. While there are risks involved with the surgery, oftentimes the benefits outweigh the potential complications, offering an improvement in symptoms and better quality of life.