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Pleurodesis is a surgical procedure focused on adhering the two lung layers together to decrease the likelihood of recurrent pleural effusions. During this process they perform a thoracentesis, removing the existing fluid from the pleural cavity in the chest. Pleural effusion is a common complication of pleural mesothelioma and other lung-related illnesses. A Pleurodesis is not a treatment for cancer but rather relieves common symptoms. It may be used during any stage of mesothelioma to help relieve symptoms and improve quality of life.
Pleural Effusion and Excess Fluid
Pleural effusion is an accumulation of fluid in the space between the two pleural layers in the chest. There are many underlying conditions that can trigger this condition. Some are malignant and others are benign. Common non-malignant causes include pneumonia, heart failure, kidney disease, and pulmonary embolism. Malignant causes are cancers like 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 have no symptoms. As the cancer progresses, the chance of developing a pleural effusion increases. These effusions may also be more severe and result in more symptoms. These symptoms include shortness of breath, a dry persistent cough, chest pain, and difficulty breathing when slouching or lying down.
Pleurodesis Removes and Prevents Fluid Buildup
A simple procedure can be done to remove the excess fluid that accumulates in the pleura. A thoracentesis is a procedure that uses a thin needle or tube to draw fluid from the pleura. The procedure is minimally invasive and doesn’t usually cause complications. However, this treatment is only a temporary measure. The fluid will soon build up again in the space, causing the pain and discomfort to return.
A pleurodesis drains the fluid for immediate relief and also aims to prevent future pleural effusions. The first step is in pleurodesis is draining the fluid completely from the pleural space. The second step, seals the pleural space so that fluid can no longer accumulate. There are two different ways to achieve this. One is a chemical injection. The other is surgery to close the space mechanically.
This procedure can either be done surgically or during a hospital stay while a chest tube is in place. A chemical pleurodesis simply pertains to the instillation of a drug into the chest cavity with the goal of sealing the lung layers together and decrease the chances of a recurrent pleural effusion. In both cases, the fluid is first drained. Then, a chemical is inserted into the pleural space. The chemical causes irritation and inflammation of the two layers of the pleura, causing the space to seal shut. The drug doxycycline or simple talc may be used to produce inflammation.
The chemical is inserted into the pleural space through a tube, which is then clamped so the material cannot drain back out. The patient then shifts position approximately every 30 minutes to ensure the substance moves around enough to seal the entire pleural space. This process can take several hours. Although generally well tolerated, pain medication can be used if patients experience discomfort.
A surgical pleurodesis is a minimally invasive surgical procedure. This procedure creates inflammation of the lining so that they stick together, leaving no space for the fluid to reaccumulate. This can be done via chemical or mechanical pleurodesis, or a combination of them both. A chemical pleurodesis involves instillation of a drug using a small incision in the chest cavity using a small camera. Common drugs used over the years include talc, bleomycin, tetracycline, doxycycline, or iodopovidone. A mechanical pleurodesis simply suggests manually irritating the pleura to create inflammation. There is usually a chest tube left in for a few days after the procedure. This helps remove any remaining fluid and provides additional suction for the lining to fully adhere together. The tube is then removed before going home.
Mesothelioma Candidates for Pleurodesis
Not all patients with mesothelioma and pleural effusion are good candidates for pleurodesis. A medical team may use thoracentesis first to determine if the patient would benefit from pleurodesis. If fluid rebuilds rapidly, the patient may need pleurodesis as a more permanent method for eliminating and preventing fluid buildup.
If cancerous tumors have spread extensively throughout the pleura, strategies for sealing the pleural space may not be effective. When a patient is in a late stage of cancer, occasional less-invasive procedures may be more appropriate. Patients who undergo other types of surgery, such as extrapleural pneumonectomy, will not need pleurodesis.
As with any procedure, pleurodesis has potential risks and complications. Some patients may react badly to the procedure and experience chest pains, infection, and fever. Although rare, the procedure may cause respiratory distress or cardiovascular problems. Pain is the most common side effect of pleurodesis. Pain medication, anti-anxiety medication, or an epidural prior to the procedure help patients deal with pain.
Malignancy along the insertion site is another possible complication of pleurodesis. This is called seeding and can be avoided by applying radiation to the area soon after the pleurodesis.
Recovery from pleurodesis should not take long for most patients. Within a few days, patients should feel better and begin to breathe more easily. In some cases, pleurodesis may fail. In these cases, the procedure did not adequately seal the pleural space, resulting in another pleural effusion. If it doesn’t work, pleurodesis may be repeated. Alternatively, a surgeon may install a permanent indwelling drain that patients can empty on their own at home.
Pleural effusion is a common and uncomfortable complication of mesothelioma. Treatment does not cure the underlying cause but can make a big difference to how a patient feels. If you are suffering from regular pleural effusions, talk to your doctor about your options. Pleurodesis may be an option to help you live more comfortable.
Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP
Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.