Management of malignant pleural effusion with different pleural catheters.

Sir,

We were greatly impressed with recent article by Dixit et al.[1] We congratulate the authors for their successful study.

We have been using in recent years the small-bore wire-guided chest drains (Pleurocan, 10F, B. Braun Melsungen, Germany) at increasing rates in our clinic for the treatment of malignant pleural effusions (MPEs). We prefer pleurocan in many MPE cases since it involves a less invasive procedure, maintains patient comfort by causing less pain, and enables making chemical pleurodesis in a similar way.[23] In our practice, after we place a catheter, we connect its end to a urine collection bag or a vacuum drainage bottle. In this way, we ensure both active drainage of the fluid and shortening of the time required for the occurrence of spontaneous pleurodesis. We have been carrying out a study in our clinic in the meantime with fifty patients who were administered pleurocan and in that study, various complications occurred, including loculated effusion in 3 (6%), empyema in 2 (4%), drain blockage in 2 (4%), drain malposition in 1 (2%), and chronic pain in 1 (2%) subject. Despite all these complications, we achieved 94% success rate and 26% spontaneous pleurodesis and we could enable this patient group with relatively short expected survey to spend this time comfortably in a home setting. Moreover, pleurocan is more cost-effective with an average price of €55 in a developing country like Turkey. An indwelling pleural catheter costs around €1750 in our country and vacuum bottles are used in greater numbers, especially in patients with large amounts of drainage, a factor further increasing the cost. Finally, we believe that the use of small-bore wire-guided chest drains in MPE cases is a reliable, well-tolerated, cheap, and effective method.

We congratulate the authors once more for their contribution to this subject. If the authors could report their views and recommendations about different catheter interventions used in MPE in general, they will increase the worth of study and will further encourage surgeons like us who deal with MPE.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.