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This Article Full Text (PDF) Free All Versions of this Article: chest.06-2141v1 132/5/1584    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jimenez, C. A. Articles by Morice, R. C. Search for Related Content PubMed PubMed Citation Articles by Jimenez, C. A. Articles by Morice, R. C.

Use of Indwelling Pleural Catheter for the Management of Recurrent Chylothorax in Patients with Cancer

Carlos A. Jimenez, MD, Assistant Professor, cajimenez@mdanderson.org, Department of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center; Ashwini D. Mhatre, MD, GRA, admhatre@mdanderson.org, Department of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center; Carlos H. Martinez, MD, Research Fellow, CHMarti@mdanderson.org. Department of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center; Georgie A. Eapen, MD, Assistant Professor, geapen@mdanderson.org, Department of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center; Amir Onn, MD, Assistant Professor, amironn@mdanderson.org, Department of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center; Rodolfo C. Morice, MD, Professor, rmorice@mdanderson.org, Department of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center

cajimenez{at}mdanderson.org

Abstract

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

MethodsIn ten years, 5,594 patients underwent 8,498 pleural procedures at our institution. Pleural fluid triglycerides were measured on 1,343 patients, and of these 130 had a chylothorax. Their medical records were reviewed. In nineteen patients, recurrent symptomatic chylothorax appeared in association with cancer relapse. Treating physicians decided to place and IPC in ten patients and nine had other palliative interventions. Baseline and post intervention 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.

ResultsThe 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 one observed in the control group (p=0.329), and recovered rapidly after IPC removal.

ConclusionsPlacement 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.