Pleurodesis

Patients who suffer from malignant mesothelioma may be presented with a number of options that are considered “palliative”.  These procedures will not cure or treat the mesothelioma but may ease symptoms and help the patient to feel more comfortable.   Pleurodesis is such a procedure.

Meso patients are often faced with breathlessness, caused by fluid retention in the pleura, the sheets of tissue covering the outside of the lung and lining the chest cavity.  Because the fluid stops the lung from fully expanding, shortness of breath occurs when fluid is present. 

Pleurodesis aims to stop the fluid buildup and ease the breathlessness.  Technically, the procedure seals the space between the pleura so that fluid can not collect there.  This is done by introducing a chemical agent, often talc or doxycycline, which will cause the tissues to become enflamed and subsequently close the space between the layers.

Pleurodesis can be performed in one of two ways. 

• In the operating room, the patient is given a general anesthetic and a thoracic surgeon makes an incision in the chest and inserts a video-assisted thoracoscope.   This allows the surgeon to see the inside of the patient’s lung and to insert the chemical agent directly on the pleural surface after draining any existing fluid.  Risks include complications due to anesthetic as well as infection or bleeding.
• The procedure may also be done outside the operating room.  Performed during hospitalization, a general anesthetic and sedative is used and a chest tube is inserted to drain existing fluid, which may take several days.  Once the fluid is gone, the talc will be inserted through the chest tube and clamped to avoid leakage.  A suction devise is then used to bring the two lung surfaces together.  The disadvantages of this procedure are that the chest tube is in place for several days, causing much discomfort and usually prompting the need for pain killers.

Not every meso patient is a candidate for this procedure.  If your lung capacity is seriously diminished, pleurodesis may not help you.  Your doctor will help you determine whether or not the procedure will work for you.