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Intrapleural perfusion thermo-chemotherapy for pleural effusion caused by lung carcinoma under VATS.

BACKGROUND
The aim of this study was to assess the effectiveness of intrapleural perfusion thermo-chemotherapy (IPTC) under video-assisted thoracoscopic surgery (VATS) for malignant pleural effusion (MPE) caused by lung carcinoma.


METHODS
In this retrospective study, fifty-four patients with moderate or large amounts of ipsilateral MPE secondary to non-small cell lung cancer (NSCLC) underwent pleural biopsy and IPTC under VATS. IPTC was performed by perfusing the pleural cavity with 43.0 °C saline solution containing cisplatin (200 mg/m2) using a devised circuit through mechanical circulation for 60 minutes. Blood pressure, heart rate, oxygen saturation (SpO2), and esophageal and rectal temperatures were monitored throughout the surgery. At the end of the perfusion, pleural biopsy was performed again for histological analysis.


RESULTS
The temperature at the pleural surface was stabilized at 43 °C, and pleural effusion was controlled in all patients. KPS scores increased in 89.3% of patients. No patient developed bone marrow suppression reactions with noticeable bleeding after treatment, and no liver and kidney malfunctions were observed. Apoptosis was detected by light and electron microscopy after IPTC. CEA markedly decreased in all patients 1 month after IPTC. The median survival time was 21.7 months, with a one-year survival rate of 74.1%.


CONCLUSIONS
IPTC under VATS is a new, safe, less invasive and more effective approach for MPE caused by lung carcinoma.