Intrapleural Hyperthermic Perfusion for Malignant Pleural Effusion Under Video-Assisted Thoracoscopic Surgery

Background: Patients with malignant pleural effusion (MPE) have a poor prognosis. Most patients are treated with tube thoracostomy and sclerotherapy but with a not satisfactory control rate of pleural effusion. This study aims to report the effect of intrapleural hyperthermic perfusion for MPE which is a standard practice at our center.Methods: This is a retrospective study of consecutive patients with MPE treated with hyperthermic perfusion from one single Institute. The procedure was done by perfusing the pleural cavity under video-assisted thoracoscope with 43.0°C distilled water using a standard extracorporeal circuit for 60 minutes. The efficacy of treatment was classified as follows: 1. complete response (CR; no re-accumulation of pleural effusion after IPH for at least four weeks); 2. partial response (PR; pleural effusion was reduced by 50% and this situation was sustained for four weeks; 3. no consequence (NC; pleural effusion was not reduced.Results: From January 2014 through December 2018, a total of 31 patients with MPE were treated using this technique. There were no serious reportable clinical complications associated with the procedures. The response rate was 100%, with 67.7% of PR and 32.3% of CR. The survival time ranged from 2 to 46 months, with a median survival of 12 months. The survival time of the patients received TKI treatment after IHP ranged from 13 to 45 months, with a median survival of 28 months. Multivariable analysis showed that TKI treatment (P=0.013) and male gender (P=0.004) were independent prognosis factors.Conclusions: Intrapleural hyperthermic perfusion is a feasible and safe strategy for patients with malignant pleural effusion.