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Surgical Perspectives on Management of Malignant Pleural Effusions

Malignant pleural effusion (MPE) is frequently encountered in the terminal phase of a patients’ disease. Most important at this point is swift and effective palliation of dyspnea related to the MPE. To this end, the morbidity of any intervention must be carefully considered. Interventions for symptomatic MPE include thoracentesis, percutaneous catheter placement, bedside tube thoracostomy, video-assisted thoracic surgery, and decortication. Of these, the 2 most common options for surgical management of MPE are tunneled pleural catheters and video-assisted thoracic surgery with talc poudrage. Successful palliation demands balancing patients’ wishes, performance status, and prognosis with the ability to obtain full-lung expansion and control fluid production. There is no ideal procedure; surgical treatment must be individualized. Discussions of therapy are best conducted in the setting of a multidisciplinary care team.