What is Pleurodesis?
Pleurodesis is a treatment option for pleural mesothelioma patients who aren’t eligible for surgery. This procedure can help treat pleural effusion or the buildup of fluid in the lungs, which is a common problem with mesothelioma patients.
A major symptom of pleural mesothelioma is the buildup of fluid in the pleura, located between the layers of tissue that line the lungs and the chest wall. Pleural effusion can lead to coughing, chest pain, and breathing difficulties. If left untreated, it may lead to infection or cause the lung to collapse.
During pleurodesis, specific medicines are injected into the chest cavity, between the lungs and chest wall. The medicine initiates irritation or swelling between the two layers, stopping the buildup of air or fluid by adhering the lung to the chest wall.
Pleurodesis may be used as a standalone treatment or combined with a procedure to drain air or fluid around the lungs, called a thoracostomy or thoracoscopy. The procedure is done in the patient’s own hospital room. If a thoracostomy or thoracoscopy is combined with pleurodesis, the procedure takes place in an operating room.
- Medicine is given to control pain and help the patient relax.
- A surgeon inserts medicine (doxycycline or talc) into the chest cavity.
- The patient changes their position every 30 minutes to move the medicine around.
- The patient is able to administer their own pain medicine, called patient analgesia.
- The patient is given medicine to prevent pain and will be put under anesthesia.
- The doctor inserts a small camera for surgery into the chest area or a narrow tube.
- The fluid is drained into a collection bag and medicine is injected into the pleural space.
Regardless of where the procedure takes place (in the room or in the operating room), a chest tube will remain in place for up to 48 hours to make sure the lung sticks to the chest wall. Once the lung sticks to the chest wall, fluid is not able to build up. Daily x-rays are done to check progress.
After the procedure, the chest tube stays in place for 24 to 48 hours, or until the lung has adhered to the chest cavity. Patients who undergo surgery may be required to stay in the hospital so the medical team can track their progress.
Once the chest tube is removed, patients must clean the wound every day. There may be some extra drainage from the wound at first, but keeping a bandage over it and change the dressing regularly will keep the area clean.
Some restrictions may apply to patients while recovering, such as avoiding lotion, baths, swimming, or hot tubs. Patients may also need to take prescriptions to help control pain.
Alternatives to Surgery
There are other options for patients with pleural effusion or fluid buildup. In a catheter placement procedure, the doctor places a small tube called an indwelling pleural catheter into the patient’s chest. This procedure allows the patient to go home with the small tube and drain the fluids there.
Another alternative to pleurodesis is removing excess fluid with a needle. After the procedure, the patient doesn’t have a chest tube inserted after the procedure. However, this method isn’t permanent, and fluid is likely to come back and require further treatment.
Potential Surgical Complications
Pleurodesis is an effective procedure. However, there are some risks, which include:
- Collection of pus in the pleural space
Possible complications of a thoracostomy:
- A tube that moves out of place
- Blood clots
- Collapsed lung
- Injury to the chest wall, arteries, or lungs
Patients will likely experience some pain or soreness in the area where the chest tube was placed. Other possible side effects include fever, shortness of breath, and infection.