Identification of clinical factors predicting Pleurx catheter removal in patients treated for malignant pleural effusion.

ABSTRACT

OBJECTIVE: The objective of the study was to review the clinical records of patients undergoing insertion of a Pleur(x) catheter in the management of malignant pleural effusions. In particular, clinical parameters were analyzed for their influence on catheter removeability. METHODS: Between January 1998 and July 2006, 263 patients underwent insertion of 295 Pleur(x) catheters for malignant pleural effusion(s). Patients were allocated to one of four groups based upon the site of the primary tumor group 1 (breast), group 2 (lung), group 3 (gynecologic), and group 4 (all others). A history of prior chest irradiation, cytologic analysis (positive or negative for malignant cells), and incidence of trapped lung were also studied to determine if, in addition to the primary site, these influenced the incidence of pleurodesis. RESULTS: Overall, 58.6% of Pleur(x) catheters were removed prior to death. The incidence of spontaneous symphysis and catheter removal in groups 1 (69.6%) and 3 (72.5%) was significantly higher than in groups 2 and 4 (p<0.001). In addition, absence of a history of chest wall irradiation, cytologic positivity and a trapped lung all influenced catheter removeability to a significant degree (p<0.001). CONCLUSIONS: Pleur(x) catheters effectively relieve patients of dyspnea by evacuating the pleural space. Spontaneous pleural symphysis and catheter removal is more likely in patients with breast or gynecologic primary tumors, absence of chest wall irradiation, cytologic positivity, and complete re-expansion of the underlying lung.