Ryan Schusler1, Shari L Meyerson2,3. 1. Department of Surgery, Northwestern University, Chicago, IL, USA. 2. Department of Surgery, Northwestern University, Chicago, IL, USA. smeyerso@nm.org. 3. Northwestern University Feinberg School of Medicine, 676 N. Saint Clair St., Suite 650, Chicago, IL, 60611, USA. smeyerso@nm.org.
Abstract
PURPOSE OF REVIEW: Pericardial effusion is commonly associated with malignancy. The goals of treatment should include optimizing symptom relief, minimizing repeat interventions, and restoring as much functional status as possible. RECENT FINDINGS: Pericardiocentesis should be the first intervention but has high recurrence rates (30-60%). For patients with recurrence, repeat pericardiocentesis is indicated in those with limited expected lifespans. Extended pericardial drainage decreases recurrence to 10-20%. The addition of sclerosing agents decreases recurrence slightly but creates significant pain and can lead to pericardial constriction and therefore has fallen out of favor. Most patients with symptomatic pericardial disease have a short median survival time due to their underlying disease. In patients with a longer life expectancy, surgical drainage offers the lowest recurrence rate. Surgical approach is based on effusion location and clinical condition. Subxiphoid and thoracoscopic approaches lead to similar outcomes. Thoracotomy should be avoided as it increases morbidity without improving outcomes.
PURPOSE OF REVIEW: Pericardial effusion is commonly associated with malignancy. The goals of treatment should include optimizing symptom relief, minimizing repeat interventions, and restoring as much functional status as possible. RECENT FINDINGS: Pericardiocentesis should be the first intervention but has high recurrence rates (30-60%). For patients with recurrence, repeat pericardiocentesis is indicated in those with limited expected lifespans. Extended pericardial drainage decreases recurrence to 10-20%. The addition of sclerosing agents decreases recurrence slightly but creates significant pain and can lead to pericardial constriction and therefore has fallen out of favor. Most patients with symptomatic pericardial disease have a short median survival time due to their underlying disease. In patients with a longer life expectancy, surgical drainage offers the lowest recurrence rate. Surgical approach is based on effusion location and clinical condition. Subxiphoid and thoracoscopic approaches lead to similar outcomes. Thoracotomy should be avoided as it increases morbidity without improving outcomes.
Authors: Patrik Palacka; Pavol Janega; Hana Polakova; Jan Slopovsky; Valentina De Angelis; Michal Mego Journal: BMC Urol Date: 2022-07-18 Impact factor: 2.090