Outcomes and complications from a new local anaesthetic thoracoscopy service

Journal article

In 1994 a new service providing local anaesthetic thoracoscopy (LAT) was started in Oxford. This series describes the outcome and safety of this service during it's evolution. 90 consecutive thoracoscopies in 83 patients are reported. In all cases the following information was documented. Age, sex, asbestos and tobacco contact, pleural fluid cytology, bacteriology, pH, LDH, glucose, protein, macroscopic pleural appearances and presence of trapped lung, biopsy results, the use of talc poudrage, survival, pleurodesis success and complications. Data was stored prospectively at the time of the thoracoscopy and follow up information extracted by clinical note review and contact with other involved physicians. The gold standard for the assessment of the diagnostic accuracy of the LAT was the final clinical diagnosis at least 6 months after the procedure. Indications for the procedure were diagnostic (16) therapeutic talc poudrage (38) or both (36). The final clinical diagnosis was mesothelioma in 37 (42%), breast carcinoma in 11(12%), outer malignancy in 27(30%), tuberculosis in 2(2%), secondary pneumothorax in 3(3%) and other benign disease in 10(11%).In the 52 patients having a diagnostic examination, at the end of the thoracoscopy procedure a positive diagnosis was made in 41 (79%). In all these patients this diagnosis remained unchanged on clinical follow up. In subjects who eventually proved to have malignancy and in whom biopsies were taken, the biopsy showed tumour in 26(63%)and provided an accurate histological diagnosis in 25(61%).6 patients had trapped lung. Of the 65 patients who had talc poudrage without trapped lung 51(78%) patients required no further pleural intervention for relapse. 8 patients had tumour spread into the thoracoscopy scar (7 of these had mesothelioma). For various reasons, none of these patients had prophylactic drain site radiotherapy. No subject who had 21Gy prophylactic radiotherapy developed this complication. There were two early deaths (myocardial infarction at 8 days and CVA at 7 days), three episodes of pleural infection and one DVT, all managed medically. These results suggest LAT to be a useful diagnostic and therapeutic tool, with an acceptable complication rate even during service development.

Authors: Mackinlay, C; Gray, W; Davies, R

• Journal: Thorax
• Volume: 53
• Issue: SUPPL. 4
• Publication date: 1998-12-01
• ISSN: 0040-6376
• Language: English