Open AccessThe effectiveness and safety of computed tomographic peritoneography and video-assisted thoracic surgery for hydrothorax in peritoneal dialysis patients: A retrospective cohort study in Japan
Author(s) -
Naoya Matsuoka,
Makoto Yamaguchi,
Akimasa Asai,
Keisuke Kamiya,
Hiroshi Kinashi,
Takayuki Kuriyama,
Takahiro Kobayashi,
Hirofumi Tamai,
Takatoshi Morinaga,
Takaaki Obayashi,
Kichio Nakabayashi,
Shigehisa Koide,
M. Nakanishi,
Katsushi Koyama,
Yoshio Suzuki,
Takuji Ishimoto,
Masashi Mizuno,
Yasuhiko Ito
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0238602
Subject(s) - medicine , hydrothorax , surgery , retrospective cohort study , interquartile range , thoracoscopy , cardiothoracic surgery , thoracentesis , video assisted thoracoscopic surgery , pleural effusion , ascites
Albeit uncommon, hydrothorax is an important complication of peritoneal dialysis (PD). Due to paucity of evidence for optimal treatment, this study aimed to evaluate the effectiveness and safety of computed tomographic (CT) peritoneography and surgical intervention involving video-assisted thoracic surgery (VATS) for hydrothorax in a retrospective cohort of patients who underwent PD in Japan. Methods Of the 982 patients who underwent PD from six centers in Japan between 2007 and 2019, 25 (2.5%) with diagnosed hydrothorax were enrolled in this study. PD withdrawal rates were compared between patients who underwent VATS for diaphragm repair (surgical group) and those who did not (non-surgical group) using the Kaplan-Meier method and log-rank test. Results The surgical and non-surgical groups comprised a total of 11 (44%) and 14 (56%) patients, respectively. Following hydrothorax diagnosis by thoracentesis and detection of penetrated sites on the diaphragm using CT peritoneography, VATS was performed at a median time of 31 days (interquartile range [IQR], 20–96 days). During follow-up (median, 26 months; IQR, 10–51 months), 9 (64.3%) and 2 (18.2%) patients in the non-surgical and surgical groups, respectively, withdrew from PD ( P = 0.021). There were no surgery-related complications or hydrothorax relapse in the surgical group. Conclusions This study demonstrated the effectiveness and safety of CT peritoneography and VATS for hydrothorax. This approach may be useful in hydrothorax cases to avoid early drop out of PD and continue PD in the long term. Further studies are warranted to confirm these results.