Mesothelioma Treatments: Palliative Surgery – Pleural Catheters and Pleuroperitoneal Shunts
Pleurodesis is the most common palliative treatment for recurrent pleural effusions, but it is not an option for all patients with a diagnosis of pleural mesothelioma. Pleural effusions can seriously restrict the lungs’ ability to expand, even collapsing its supportive tissues, while aggressive tumor growth along the visceral pleura can create a thick “rind” around the lung itself, further preventing it from functioning normally. This combination of symptoms can lead to a condition which causes, or at least mimics, trapped lung syndrome, where a patient’s lung function is significantly restricted and the fluid trapped in the pleural spaces cannot be properly flushed out. In this situation, it may not be possible to perform any of the standard palliative treatments for pleural mesothelioma. Other patients may present with a disease status that requires long-term draining of the fluid from the lungs for other reasons as well. For these patient classes, pleural catheters and pleuroperitoneal shunts have been used to drain the excessive fluid build-up associated with pleural effusions and to provide some relief from the pain and dyspnea symptoms associated with them.
A catheter is a thin, hollow tube that can be used to either withdraw fluid from the body or deliver fluid into it. A pleural catheter refers to a catheter used to draw fluid from a pleural effusion out of the pleural cavity, thereby reducing/removing the effusion and its attendant symptoms. Pleural catheters are often used for the treatment of pleural effusions when more effective procedures are not an option for individual patients.
The implant procedure is a relatively straightforward process and can be completed on an outpatient basis. Depending on the type of catheter installed, the patient may be able to control the draining process him or herself, as some companies have developed home catheter drainage kits that are easily administered and maintained. Some catheter types may still require assistive nursing however.
Many patients do report improved breathing and an overall quality-of-life benefit with the use of pleural catheters, but complications are not uncommon and the procedure is purely palliative, i.e., it serves no curative function and does not improve prognosis. For these reasons, the long-term use of pleural catheters for patients with pleural mesothelioma is generally recommended only for people ineligible for pleurodesis or another surgical procedure and those with a shortened life expectancy.
A shunt, like a catheter, is a thin, hollow tube implanted in the body to correct a fluid imbalance. However, a shunt is used to divert fluid from one part of the body to another, not to extract it from the body. A pleuroperitoneal shunt, then, is a shunt that drains the fluid from a pleural effusion into the peritoneum. A properly placed and maintained shunt can be used for years and is an effective treatment for relief of symptoms for cancer patients with recurrent effusions.
However, pleuroperitoneal shunting is not generally recommended for patients with pleural mesothelioma because the fluid in the effusion is likely to be malignant, so there is a risk that the tumor will be spread into the abdomen. Other procedures have proven much more effective for the treatment of pleural effusions and they hold less risk for the cancer spreading, but not everyone is eligible for them. For these patients then, a pleuroperitoneal shunt can greatly reduce the pain and discomfort that is associated with pleural effusions and, therefore, lead to a real quality-of-life improvement for them.
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