mydadstage4
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My dad has stage 4 lung cancer.
He had a pleurodesis on January 27, 2015. At the time of this question (February 22), he still has a chest tube because of air bubbles in the lungs, but surgeon states it should heal shortly.
He still gets about 120 to 150 cc's of pleural effusion excreted through his heimlich valve chest tube every 12 hours. Will this amount of fluid successfully reabsorb without fluid build up if his chest tube is removed?
What's the maximum amount of pleural effusion that should be coming out of his chest tube every 12 hours for a pleurodesis to be considered successful?
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Reply # - February 22, 2015, 02:20 PM
I don't know that there's a
I don't know that there's a specific number for that. The success of a pleurodesis is really just functionally defined as no longer needing to remove fluid once drains are out and the acute process is completed. About 30% of the time, the lung doesn't re-expand enough to fill the space otherwise occupied by the fluid, or not enough inflammation and scarring occur to "tack" the outside of the lung to the inside of the chest wall. So while a pleurodesis is effective more often than not, failure of a pleurodesis isn't rare. However, the real question is whether, if the Heimlich valve is removed, there would only be a small amount of fluid accumulating before the pressure in the space becomes great enough to prevent further fluid from accumulating.
Good luck.
-Dr. West
Reply # - February 22, 2015, 05:57 PM
Dr. West thank you for the
Dr. West thank you for the response. I see there's no real quantitative answer then. Hmm, gosh, does that mean we won't know for sure whether the pleurodesis worked until the tube is pulled?
Or can x-rays or other means show whether there has been enough adhesion of the lungs to the walls to ensure sufficient blockage of water?
My dad has undergone his first week of chemotherapy. Can we expect a progressive decline of the malignant pleural effusion if the chemotherapy is successfully working to kill the cancer cells? Or is just the first week into chemotherapy too soon to expect to help resolve the excessive pleural effusion issue?
I get distressed to think my dad would need other procedures as his first pleurodesis proved to be very harrowing and complicated with the air leak and a 10 day hospital stay before he was released with his tube.
Reply # - February 23, 2015, 09:35 AM
Although occasionally chemo
Although occasionally chemo can have dramatic effects fairly quickly, one week is really not enough time to be able to judge whether it's helping. For that reason, most oncologists re-scan at the end of the second or third cycle (6-8 weeks). Although chemo can be expected to kill cancer cells wherever they are in the body, it is not uncommon to continue to have problems with effusions. On the other hand, if the pleurodesis has been successful, that it less likely to be a problem.
The main reason to remove the pleural fluid and try to prevent its re-accumulation is symptom management. So if the lung re-expands and the symptoms of the effusion are gone or significantly reduced, and remain so, then the procedure has done its job.
That result, along with a good response to chemo, is what we will hope for.
JimC
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