Letters Malignant pleural effusion

Video assisted thoracoscopic surgery is still the standard

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39115.401412.1F (Published 08 February 2007) Cite this as: BMJ 2007;334:273
  1. Loic Lang-Lazdunski, consultant thoracic surgeon (loic.lang-lazdunski{at}gstt.nhs.uk),
  2. John E Pilling, specialist registrar in thoracic surgery
  1. 1Department of Thoracic Surgery, Guy's Hospital, London SE1 9RT

    We were surprised that Rahman et al did not mention video assisted thoracoscopic surgery in investigating malignant pleural effusion.1For more than 15 years it has been the cornerstone of investigation and palliation of such disease in those fit for general anaesthesia.1 Complex loculated effusions can be evacuated and the pleural cavity debrided appropriately.

    The systematic examination of the mediastinum, pericardium, and diaphragm as well as the visceral pleura and underlying lung is easily and safely performed. Multiple targeted pleural biopsies can be performed, as well as biopsies of mediastinal nodes as required.

    The expansion of the lung in response to positive pressure ventilation determines the appropriate method of palliation. If there is apposition of the visceral and parietal pleura talc pleurodesis is the method of choice, where this does not occur talc is detrimental and potentially leads to empyema. In most series, surgical talc insufflation provides superior palliation to talc slurry.

    Lastly, as a thoracic surgeon operating on a large volume of patients with malignant mesothelioma, video assisted thoracoscopic surgery represents an excellent staging tool and determinant of the best surgical option for such patients..


    • Competing interests: None declared.


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