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First published online on September 21, 2007
Chest, doi:10.1378/chest.06-2141
doi:10.1378/chest.06-2141
(Chest. 2007; 132:1584-1590)
© 2007 American College of Chest Physicians
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Use of an Indwelling Pleural Catheter for the Management of Recurrent Chylothorax in Patients With Cancer*

Carlos A. Jimenez, MD, FCCP; Ashwini D. Mhatre, MD; Carlos H. Martinez, MD; Georgie A. Eapen, MD; Amir Onn, MD and Rodolfo C. Morice, MD, FCCP

* From the Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX.

Correspondence to: Carlos A. Jimenez, MD, FCCP, Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 403, Houston, TX 77030; e-mail: cajimenez{at}mdanderson.org

Abstract

Background: Recurrent chylothorax is a debilitating condition. We describe the usefulness of an indwelling pleural catheter (IPC) in the palliative management of recurrent symptomatic chylothorax in patients with cancer relapse or progressive disease despite adequate treatment.

Methods: In 10 years, 5,594 patients underwent 8,498 pleural procedures at our institution. Pleural fluid triglycerides were measured in 1,343 patients; of these patients, 130 had a chylothorax. Their medical records were reviewed. In 19 patients, recurrent symptomatic chylothorax appeared in association with cancer relapse. Treating physicians decided to place an IPC in 10 patients, and 9 patients had other palliative interventions. Baseline and postintervention changes in weight, absolute lymphocyte counts, and albumin levels in both groups were statistically compared. Hazard ratio and Kaplan-Meier curves of time to second pleural intervention after index procedure were also evaluated.

Results: The risk of requiring a second pleural intervention after the index procedure during the following 500 days was lower in the IPC group compared to the other pleural interventions (p = 0.030), and Kaplan-Meier curves of time to second intervention were statistically different (p = 0.025). Albumin levels decrease in the IPC group (p = 0.007), but the decline was not worse than the decline observed in the control group (p = 0.329), and recovered rapidly after IPC removal.

Conclusions: Placement of an IPC may be considered as first-line palliative management for patients with symptomatic recurrent chylothorax poorly responsive to the treatment of the underlying malignancy.

Key Words: chylothorax • indwelling intrapleural catheter • pleural effusion






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