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Malignant pleural effusion (MPE) is a frequent clinical problem, affecting 15% of patients with cancer. It frequently confers a poor prognosis and causes numerous oppressive symptoms as dyspnoea, dry cough and pain. Several different approaches have been proposed to manage MPE and relieve patients’ symptoms. The selected approach depends on predicted patient survival (LENT or PROMISE SCORE), patient preferences and availability of the different techniques. Repeated thoracentesis, chemical pleurodesis via chest tube or thoracoscopy (medical or surgical), mechanical surgical pleurodesis, pleurectomy/ decortication and application of indwelling pleural catheter (IPC) or pleuro-peritoneal shunt are the most common utilized approaches. The gold standard procedure for the management of an MPE is pleurodesis. Chemical pleurodesis can be obtained by the instillation of a sclerosant agent into the pleural space through an intercostal chest tube after complete evacuation of fluid (“slurry pleurodesis”) or during a thoracoscopy (“poudrage pleurodesis”) which also consents to visualize the all pleural cavity, assess the possibility of lung re-expansion and remove the eventually present loculation/pleural bridge. An alternative approach is the use of IPC, which consists of a chest tube tunnelled under the skin allowing intermittent fluid drainage. This approach has shown to have several advantages in trapped lung, a condition in which the lung parenchyma cannot completely rehabilitate the pleural cavity, but also it has been increasingly utilized for the primary management of MPE as an alternative to chemical pleurodesis. The aim of this review is to analyse the role of surgery in pleurodesis for MPE.

Possibilities of surgical pleurodesis for malignant pleural effusion