Chest
Original Research: Pulmonary ProceduresCatheter Tract Metastasis Associated With Indwelling Pleural Catheters
Section snippets
Materials and Methods
All patients who had IPC insertion for MPE in our service were entered prospectively into a database, which was interrogated for the period of July 31, 2009, to February 28, 2013. All IPCs were inserted using standard procedures involving a modified Seldinger approach and subcutaneous tunneling. In our center, patients were instructed to perform pleural drainage via the IPC whenever they became symptomatic. CTM cases were captured through review of individual medical records and available
Results
During the study period, 107 patients underwent insertion of 110 IPCs (Rocket Medical plc) for MPE management (Table 1). One patient had IPCs inserted bilaterally, another had two IPCs inserted into separate collections on the same side, and one had IPCs inserted sequentially on the same side. For the purpose of data analysis, individual IPC insertions (n = 110) rather than individual patients were used. Mesothelioma was the commonest underlying malignancy (60%). No patient received
Discussion
This is the largest reported series of IPC-related catheter tract metastases to our knowledge. We showed that CTM could occur particularly, but not exclusively, in patients with mesothelioma, and often causes pain. Radiotherapy is effective and can be delivered safely with the catheter in situ. Our study showed that the duration after IPC placement is the most significant and sole predictor for development of CTM.
IPCs are increasingly used in the management of MPEs worldwide, and their benefits
Conclusions
In summary, clinicians using IPC should be aware of CTM, especially as a late complication, in patients with mesothelioma and metastatic malignancies. Patients should be educated to report early lesions. Radiotherapy appears effective, and removal of IPC is unnecessary.
Acknowledgments
Author contributions: Y. C. G. L. is guarantor of the study. R. T. and Y. C. G. L. contributed to conception and design of the study, pleural data collection, and drafting, revision, and final approval of the manuscript; C. A. B. contributed to statistical analyses and drafting, revision, and final approval of the manuscript; Y. J. K. contributed to imaging analyses and drafting, revision, and final approval of the manuscript; C. R. and E. T. H. F. contributed to pleural data collection and
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2018, Annals of OncologyCitation Excerpt :Catheter-related complications include malfunction, blockage, and site-related pain [15]. The reported incidence of procedure-tract metastases ranges in available literature from <1% to 10% [16, 17]. Currently, comparative data are missing whether talc pleurodesis or IPC produces superior palliation, shorter hospital stay, and less morbidity.
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2018, Clinics in Chest MedicineCitation Excerpt :In one study, they were reported in 1.9% of the cases.46 However, these show a good response to radiation therapy.55 Mild pain following catheter insertion is common; severe pain necessitating catheter removal is only reported in 0.6% cases.56
FUNDING/SUPPORT: Drs Fysh and Lee have received research grant support from the Sir Charles Gairdner Research Foundation, Cancer Council of Western Australia, Lung Institute of Western Australia (LIWA) Westcare, and the Dust Disease Board of New South Wales, Australia. Dr Lee is a recipient of a National Health and Medical Research Council (NH&MRC) Career Development Fellowship. Dr Thomas has received research scholarship support from NH&MRC, Western Australia Cancer and Palliative Care Network (WACPCN), and LIWA, Australia.
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