A pleurodesis is a surgical procedure used to treat and prevent pleural effusion. It is recommended to pleural mesothelioma patients when symptoms, such as chest pain and shortness of breath, cause discomfort.
Pleural effusion is the buildup of excess fluid in the pleural space, the space between the visceral lining and parietal lining of the lungs. The goal of a pleurodesis is to eliminate the pleural space so that fluid can no longer accumulate.
Considered the best palliative treatment (which aims to ease symptoms rather than cure disease) for pleural effusions, this common procedure for mesothelioma patients is usually performed in a hospital and calls for a three- to seven-day stay. The treatment is considered more effective than a thoracentesis, which drains the fluid of pleural effusions but does not close the pleural space, and thus allows accumulation of fluid.
The benefits of pleurodesis include:
Not all mesothelioma patients are candidates for a pleurodesis.
For example, if a patient has extensive tumor coverage of the visceral and parietal linings, a pleurodesis is less effective at sealing the pleural space. Patients with a life expectancy of a few months may not undergo the procedure because they may want to avoid surgical procedures and any discomfort associated with recovery.
If mesothelioma has progressed and the pleural cavity is compromised, a pleurodesis is no longer recommended and additional palliative treatments will be considered. According to a 2017 review of the procedure for malignant pleural effusions, patients with a trapped lung do not benefit from pleurodesis.
Mesothelioma patients diagnosed before stage 4 will qualify for a pleurodesis, and some stage 4 patients will qualify as well. Patients with a longer life expectancy and those in severe pain from pleural effusion may undergo a pleurodesis, and they will benefit from pain relief after the fluid is drained and tissues heal from the procedure. If a patient qualifies for a more aggressive surgery, such as a pleurectomy/decortication, a pleurodesis is not performed.
FAST FACT: In many cases, mesothelioma patients first undergo a diagnostic thoracoscopy before a pleurodesis is considered. During the thoracoscopy, a biopsy is collected and pleural effusion fluid is drained. Quick recurrence of the effusion indicates that the patient will benefit from a pleurodesis.
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The first step involves draining excess fluid from the pleural space. This is a very important step because the efficacy of the procedure will depend on whether the pleural space is free of fluid. Once the fluid is drained, there are two methods for producing inflammation on the pleural linings: Chemical and mechanical.
Before the procedure, patients will usually be medicated with a narcotic for pain and a benzodiazepine, such as Xanax, for comfort. Because of the low cost and ease of the procedure, a chemical pleurodesis with talc is the most common method.
Once all the fluid has been removed, talc will be inserted through a chest tube to cause inflammation in the chest cavity. After the talc has been administered, patients will be asked to lie down for a few hours and periodically change positions so that the talc is evenly distributed throughout the pleural space. Once sufficiently distributed, the talc will be removed via the same chest tube.
As the talc is suctioned from the pleural cavity, the pleural space will become sealed with scar tissue and fluid won’t be able to accumulate in the future. The talc for pleurodesis is medical grade, sterile and asbestos-free. The most common talc pleurodesis side effects include chest pain and fever.
Substances such as bleomycin, tetracycline, nitrogen mustard and povidone iodine can also be used in substitute of talc for a chemical pleurodesis, but talc is the most popular option. It’s also the least expensive to administer.
A pleurodesis can involve more invasive surgery if a doctor feels a different approach will present better results. In this scenario, a thoracoscopy is performed and inflammation is achieved by irritating the pleura with a rough pad, gauze or a mechanical rotary brush. The two lung lining layers are then fused together to eliminate any space for fluid retention. Any suspicious tissue can also be removed during this type of pleurodesis.
The following are common side effects and complications of a pleurodesis:
Chest pain and fever are the most common adverse effects of a pleurodesis. Some patients report a tight or burning feeling around the lungs, but this is usually eased with medication prior to the procedure. Because of the inflammatory response that helps to close the pleural space, a fever commonly develops about four to 12 hours after a talc pleurodesis.
Another possible complication of a pleurodesis is malignant growth at the site where the chest tube was inserted. This type of metastasis is referred to as seeding, but radiation therapy along the insertion site after the procedure can prevent seeding.
After a short recovery from the procedure, patients should feel a big difference in their ability to breathe. More than 95 percent of patients with pleural effusion experience shortness of breath, cough, fever and pain. Following a pleurodesis, such symptoms should decrease.
A 2013 Australian review of pleurodesis in mesothelioma patients confirmed the talc pleurodesis as the most effective treatment. A 2016 Cochrane review also found talc pleurodesis the most effective for malignant pleural effusions.
Similar benefits of the talc pleurodesis were reported in a 2014 British study, but it also reported higher quality of life among patients who underwent a partial pleurectomy (removal of the pleural lining) instead of pleurodesis.
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