Marco Scarci1, Edward Caruana2, Luca Bertolaccini3, Benedetta Bedetti1, Alessandro Brunelli4, Gonzalo Varela5, Kostas Papagiannopoulos4, Jaroslaw Kuzdzal6, Gilbert Massard7, Enrico Ruffini8, Pierre Emmanuel Falcoz7, Isabelle Opitz9, Hasan Batirel10, Alper Toker11, Gaetano Rocco12. 1. Department of Thoracic Surgery, University College London Hospitals, London, United Kingdom. 2. Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom. 3. Department of Thoracic Surgery, Sacro Cuore, Don Calabria Research Hospital, Negrar, Verona, Italy. 4. Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom. 5. Department of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain. 6. Department of Thoracic Surgery, Jagiellonian University Collegium Medicum, John Paul II Hospital, Cracow, Poland. 7. Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France. 8. Department of Thoracic Surgery, University of Torino, Torino, Italy. 9. Division of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland. 10. Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey. 11. Department of Thoracic Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey. 12. Division of Thoracic Surgery, Department of Thoracic Surgical and Medical Oncology, Istituto Nazionale Tumori, Fondazione Pascale, IRCSS, Naples, Italy.
Abstract
Objectives: Malignant pleural effusion (MPE) commonly complicates advanced malignancy and their exact management is still undefined. We undertook a survey to determine the current practice among members of the European Society of Thoracic Surgeons (ESTS). Methods: A cross-sectional survey focused on the current practice of management of MPE was developed by the authors. The questions were outlined after a review of the literature and circulated in an Internet-based survey format. Results: Computed tomography (125, 92%) and chest X-ray (106, 78%) are the most common imaging modalities performed in the initial evaluation. Video-assisted thoracoscopic surgery for washout and pleurodesis (93, 68%) was reported as the preferred approach to patients with uncomplicated MPE. Sixty-one (45%) of the responding colleagues routinely use large bore chest tubes for draining malignant effusions. Forty-nine (35%) surgeons would not apply suction to the drainage system, whilst 50 (37%) would use -2 kPa or less. Talc (124, 91%) is the most commonly used sclerosing agent for pleurodesis in the context of malignant pleural effusion. The practice of 76 (56%) of the respondents is not informed by any clinical guidelines, whilst 60 (44%) reported adhering to the 2010 British Thoracic Society Pleural Disease Guideline. Seventy-one (52%) declared that the guidance was in need of updating or revision. Conclusions: This survey demonstrates the lacking adoption of the existing clinical guidance in this field, as well as the need for more contemporary guidelines for a better-informed practice. The ESTS Working Group on the management of MPE has been established for this purpose.
Objectives:Malignant pleural effusion (MPE) commonly complicates advanced malignancy and their exact management is still undefined. We undertook a survey to determine the current practice among members of the European Society of Thoracic Surgeons (ESTS). Methods: A cross-sectional survey focused on the current practice of management of MPE was developed by the authors. The questions were outlined after a review of the literature and circulated in an Internet-based survey format. Results: Computed tomography (125, 92%) and chest X-ray (106, 78%) are the most common imaging modalities performed in the initial evaluation. Video-assisted thoracoscopic surgery for washout and pleurodesis (93, 68%) was reported as the preferred approach to patients with uncomplicated MPE. Sixty-one (45%) of the responding colleagues routinely use large bore chest tubes for draining malignant effusions. Forty-nine (35%) surgeons would not apply suction to the drainage system, whilst 50 (37%) would use -2 kPa or less. Talc (124, 91%) is the most commonly used sclerosing agent for pleurodesis in the context of malignant pleural effusion. The practice of 76 (56%) of the respondents is not informed by any clinical guidelines, whilst 60 (44%) reported adhering to the 2010 British Thoracic Society Pleural Disease Guideline. Seventy-one (52%) declared that the guidance was in need of updating or revision. Conclusions: This survey demonstrates the lacking adoption of the existing clinical guidance in this field, as well as the need for more contemporary guidelines for a better-informed practice. The ESTS Working Group on the management of MPE has been established for this purpose.
Authors: Deirdre B Fitzgerald; Calvin Sidhu; Charley Budgeon; Ai Ling Tan; Catherine A Read; Benjamin C H Kwan; Nicola Ann Smith; Edward T Fysh; Sanjeevan Muruganandan; Tajalli Saghaie; Ranjan Shrestha; Arash Badiei; Phan Nguyen; Andrew Burke; John Goddard; Morgan Windsor; Julie McDonald; Gavin Wright; Kasia Czarnecka; Parthipan Sivakumar; Kazuhiro Yasufuku; David J Feller-Kopman; Nick A Maskell; Kevin Murray; Y C Gary Lee Journal: Trials Date: 2022-06-27 Impact factor: 2.728