Malignant pleural effusion—still an actual issue

With the widespread use of video-assisted thoracic surgical procedures, the focus of the clinicians in patients with malignant pleural effusion (MPE) moved from diagnostics to most efficient therapeutic options that are expected to provide both a survival benefit and quality of life. The decision-making process in practice is influenced by different causes of MPE—primary lung cancer, extrathoracic malignancies or pleural mesothelioma.

Faced with these patients groups, practicing physicians are faced with the need to subdivide these groups: in patients with lung cancer to assess whether the effusion is caused by pleural carcinosis (in which case surgery is not an option) or not, in patients with MPE and mesothelioma to perform a meticulous selection for one of possible surgical options vs. nonsurgical treatment, whilst in patients with extrathoracic malignancies, the main task is to select a suitable palliation of the usually rapidly accumulating fluid.

Despite all advantages of modern imaging procedures, ultrasound-guided interventions, and VATS, in patients with trapped lung diagnostics and treatment may be difficult. Although different techniques of pleurodesis are well documented, their application in practice is highly individualized, requiring their optimal combination with best available oncological treatment and/or best supportive care.

In brief, although the MPE is not a top priority in thoracic surgical and oncological community as, for example, the role of VATS segmentectomy vs. VATS lobectomy in patients with early lung cancer, having in mind a high number of patients with MPE worldwide, the updated knowledge about optimal diagnostic and therapeutic approach in these patients still remains actual in clinical practice.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by editorial office, AME Medical Journal for the series “Malignant pleural effusion”. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://amj.amegroups.com/article/view/10.21037/amj-2019-mpe-08/coif). The series “Malignant Pleural Effusion” was commissioned by the editorial office without any funding or sponsorship. Dragan Subotic served as the unpaid Guest Editor of the series and serves as unpaid Associate Editor-in-Chief of AME Medical Journal. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Dragan Subotic