Do thoracentesises negatively impact the outcome of a subsequent pleurodesis?

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This topic contains 2 replies, has 2 voices, and was last updated by  lucette 3 weeks, 5 days ago.

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December 20, 2017 at 12:13 pm  #1293658    

lucette

Hello,
I have stage-4 breast cancer, spread to the pleura, lung, pericardium, spine, omentum, etc. I had a pleurodesis on the left a year ago. Now my right pleura is full of fluid also. I had one thoracentesis a month ago. A week later, it had refilled. Now I am on oxygen therapy. I am scheduled for a pleurodesis in a month and would like to have my lung drained again before then to improve my quality of life.
My cardiothoracic surgeon thinks that more than one thoracentesis before a pleurodesis may negatively impact the result of teh pleurodesis, though. I think he means because of locutions or adhesions or scar tissue that may for as a result of a thoracentesis. Is this a widely-held and substantiated belief? Do you agree that multiple thoracentesis should be avoided in order to maintain optimal conditions for the best possibly outcome for a future pleurodesis? My oncologist disagrees with my cardiothoracic surgeon and thinks I can have my lung drained as often as I need to to be comfortable.
Do you have an opinion on the above? Any studies to back it up?
Thank you!
Confused, L-

December 20, 2017 at 2:28 pm  #1293660    
JimC Forum Moderator
JimC Forum Moderator

Hi lucette,

Welcome to GRACE. Although it is not unusual for patients to have multiple thoracenteses prior to an eventual pleurodesis, with each thoracentesis there is a risk that the effusion will become loculated. When that happens, there is no longer one continuous area of fluid but two or more separate areas, which complicates future attempts to drain the fluid, since you can’t get to all of the fluid in a single procedure – each area would need to be drained separately.

As was stated in this article from the Eurasian Journal of Medicine: “Increased symptoms and loculated effusion can be seen after repeated thoracentesis. Other treatment modalities should be kept in mind when recurrent effusions occur.” On the other hand, they noted that another study

“documented that repeated thoracentesis can cause pleural inflammation and increased TNF–alpha release. They also declared that fibrin formation can be seen secondary to thoracentesis in MPE and that the presence of fibrin increased the success of later pleurodesis.”

I haven’t found any other reason that repeat thoracenteses could reduce the success of a later pleurodesis.

JimC
Forum moderator


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December 20, 2017 at 2:44 pm  #1293661    

lucette

Thanks for your reply. Yes, I’d read and been confused by the second study you mention before. It was helpful to pull up the first, though.

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