Pleurodesis

Pleurodesis is a surgical procedure that is used to remove fluid from the pleural cavity in the chest and to prevent it from accumulating again. This procedure treats pleural effusion, a common complication of pleural mesothelioma and other lung-related illnesses. It is not a treatment that acts against the cancer, but it does bring relief from some of the symptoms that are common to it: shortness of breath, pain, and others. Pleurodesis may be used for someone in any stage of mesothelioma to help relieve symptoms, improve quality of life, and as part of palliative care.

Pleural Effusion and Excess Fluid

Pleural effusion occurs when fluid builds up in the pleural cavity, the space between the two layers of the pleura in the chest. There are many underlying conditions that can cause this to happen, including those that are malignant and non-malignant. Non-malignant common causes include pneumonia, heart failure, kidney disease, and pulmonary embolism. Malignant causes are cancer and may include lung cancer or pleural mesothelioma.

The buildup of fluid in the pleural space can be very uncomfortable. In early stages of mesothelioma a patient may not experience this and may have no symptoms. As the cancer progresses, effusions become more likely and more severe, and cause more symptoms. These include shortness of breath that makes activity difficult, a dry, persistent cough, chest pains, and difficulty breathing when slouching or lying down.

Pleurodesis Removes and Prevents Fluid Buildup

A simple procedure can be done to remove the buildup caused by a pleural effusion. A thoracentesis involves inserting a thin needle or tube into the pleural space and withdrawing the fluid. It is minimally invasive and doesn’t usually cause complications, but it is a temporary measure. The fluid will soon build up again in the space, bringing back discomfort and pain.

A pleurodesis is a procedure that both drains the fluid for immediate relief and aims to prevent future pleural effusions. The first step is to drain the fluid completely from the pleural space. The second step is to seal up the pleural space so that fluid cannot accumulate there. There are two different ways to achieve this: through the injection of a chemical or through surgery to mechanically close the space.

Chemical Pleurodesis

To perform a pleurodesis chemically, the fluid is first drained and then a chemical is inserted into the pleural space. The chemical causes irritation and inflammation of the two layers of the pleura, which causes the space to seal shut. Talc may be used as the chemical to produce inflammation. Another option is the drug doxycycline.

The drug or talc is inserted into the pleural space through a tube, which is then clamped shut so that the material cannot drain back out. The patient will then have to shift position approximately every 30 minutes to ensure that the drug or the talc moves around enough to seal off the entire pleural space. This process takes a couple of hours and it does cause pain and discomfort. Most patients are given painkillers to better tolerate the procedure.

Surgical Pleurodesis

Pleurodesis with talc is the most common way to achieve a sealing of the pleura space because it is inexpensive and not very invasive for the patient. If the doctor sees any reason why a patient would not react well to chemical pleurodesis a surgeon may seal the pleural space mechanically. This is much more invasive and may cause complications common to surgery in general, such as infection or bleeding. To perform this procedure, the surgeon uses an abrasive, like gauze or a brush to cause irritation and inflammation.

Mesothelioma Candidates for Pleurodesis

Not all patients with mesothelioma and pleural effusion are good candidates for undergoing a pleurodesis. One way that a medical team may determine if a patient could benefit from a pleurodesis is to drain fluid using thoracentesis first. If the fluid rebuilds rapidly, the patient may need a pleurodesis as a more permanent method for eliminating and preventing fluid buildup.

If the tumors have spread extensively throughout the pleura, these strategies for sealing the pleural space may not be effective. If a patient is in a late stage of the cancer, it may be better to have an occasional, less-invasive thoracentesis to remove fluid and to avoid surgery. Patients who are undergoing other types of surgery to treat mesothelioma, such as an extrapleural pneumonectomy will not likely need a pleurodesis.

Complications

As with any procedure, there are potential risks and complications with a pleurodesis. Some patients may react badly to the procedure and may experience chest pains, an infection, and a fever. More rarely the procedure may cause respiratory distress or cardiovascular problems. Pain is the most common side effect of pleurodesis, but patients can be given painkillers, anti-anxiety medications, or an epidural prior to beginning. It is also possible that a malignancy will grow along the insertion site. This is called seeding and it can be avoided by applying radiation to the area soon after the pleurodesis.

Recovery

Recovery from pleurodesis should not take long for most patients, especially if there are no complications associated with the procedure. The vast majority of patients respond favorably to pleurodesis. Within a few days patients should be feeling better and breathing more easily. In rare cases the pleurodesis may fail, meaning it did not adequately seal the pleural space and the pleural effusion may recur. If it doesn’t work the pleurodesis may be repeated or the patient may be given the option to try other treatments, such as having a shunt surgically installed to drain fluids regularly.

Pleural effusion is a common complication of mesothelioma, but it is also a very uncomfortable one. Treating it will not help treat the cancer, but it can make a big difference to how a patient feels and in improving quality of life. If you are suffering from regular pleural effusions, talk to your doctor about your options and the possibility of having a pleurodesis or other procedure that will help you live more comfortably.