Thoracoscopic Assisted PleuralPortTM Application in Seven Dogs Affected by Chronic Pleural Effusion

Our plain-English summary of Thoracoscopic Assisted PleuralPortTM Application in Seven Dogs Affected by Chronic Pleural Effusion, by A. Bianchi, F. Collivignarelli, A. Paolini, et al (Veterinary Sciences, 2023).

The study

• Authors: A. Bianchi, F. Collivignarelli, A. Paolini, M. Vignoli, G.W. Niebauer, G. Dolce, S. Canal, A. De Bonis, M. Rosto, F. Del Signore, R. Tamburro
• Journal: Veterinary Sciences
• Published: 2023;10(5)
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Chronic non-septic pleural effusion is a condition that frequently may occur because of lung or pleural neoplasia, or chylothorax refractory to surgical treatment, in dogs. Effusion management can be performed with multiple pleurocenteses or the application of chest drains. New modified vascular devices have been used for patients with chronic diseases; they offer the advantage of allowing home management and do not require hospitalization. Eight PleuralPortTM devices were applied in seven dogs during thoracoscopic exploration and biopsy procedures; five were affected by mesothelioma; one by lung metastases from a mammary carcinoma; and one by chronic chylothorax. The median time of surgical procedure was 51 min; one developed pneumothorax post-operatively that resolved within 12 h after repeated drainage; one device was obstructed after 45 days and was successfully managed by flushing. All patients were discharged after 24 h. The median duration of port insertion in cancer patients was 5 months and those dogs were euthanized because of tumor progression; in the dog with chylothorax, the device was removed after 1 year when the effusion had resolved.

In plain English

This veterinary case series from the University of Teramo, Italy, does not discuss asbestos. Between 2019 and 2021, the authors placed eight PleuralPort devices (drainage tubes connected to a port under the skin) in seven dogs with long-lasting fluid around the lungs (pleural effusion). The devices were placed during keyhole chest surgery (thoracoscopy), done alone or with surgical biopsies. Five dogs had malignant mesothelioma, one pleural carcinomatosis with lung metastasis from a mammary carcinoma, and one chronic chylothorax. The dogs with mesothelioma also received cisplatin through the port. Median surgery time was 51 minutes. One dog developed pneumothorax that resolved after 12 hours. Another dog's port blocked after 45 days and was cleared by flushing. The dogs with mesothelioma were euthanized for disease progression on average 5 months after placement. The dog with carcinomatosis was euthanized 5 months after placement. In the dog with chylothorax, the effusion resolved and the port was removed after about a year. The authors concluded that thoracoscopic placement was feasible. They cited the small number of dogs and their mixed diseases as limitations.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Veterinary clinical case series describing a surgical technique: PleuralPort devices placed during exploratory thoracoscopy, done alone or with surgical biopsies, in dogs
• Who was studied: Seven dogs (four neutered females, three males) with chronic non-septic pleural effusion, presented between 2019 and 2021 at the Department of Veterinary Medicine, University of Teramo, Italy. Five had malignant mesothelioma, one had pleural carcinomatosis with pulmonary metastasis from a mammary carcinoma, and one had chronic chylothorax.
• Exposure: No asbestos or fiber exposure was studied. The intervention was thoracoscopic placement of PleuralPort devices. The five dogs with malignant mesothelioma also received intracavitary cisplatin 50 mg/m2 every 3 weeks through the port for four doses, plus daily oral piroxicam 0.3 mg/kg for 4 months.
• Main results:
  • Eight PleuralPort devices were placed in seven dogs.
  • In the seven dogs, median surgical time, including exploration and biopsy, was 51 minutes (range 35 to 80).
  • One dog (case 7, chylothorax) developed pneumothorax after fluid aspiration. It resolved after 12 hours with port aspiration every 3 hours.
  • One dog (case 6, pleural carcinomatosis) had a tube obstruction 45 days after placement. It was managed by flushing with sterile saline. No other complications were seen.
  • At the 7-day follow-up, no dog showed signs of surgical site infection, oedema, seroma, or fluid leakage around the device.
  • The five dogs with malignant mesothelioma were euthanized on average 5 months after device placement because of disease progression. Table 1 gives the individual times as 4, 5, 6, 5 and 5 months.
  • The dog with pleural carcinomatosis was euthanized 5 months after port placement, after increasing effusion, fever, and episodes of collapse.
  • In the dog with chylothorax, the effusion resolved spontaneously after 1 year and the port was removed. Table 1 gives resolution after 355 days.
  • None of the dogs that received intrapleural cisplatin showed signs of renal toxicity.
• The authors' conclusion: The authors concluded that thoracoscopy allows the PleuralPort device to be placed, the pleural cavity to be explored, and visible lesions to be biopsied. They added that the device allows drainage without repeated thoracocenteses.
• Limitations the authors state:
  • The study included a small number of dogs.
  • The dogs had a mix of different diseases.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Biopsy, Mesothelioma, Carcinoma, Pneumothorax.

Related studies

• Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis — T. Laisaar, V. Palmiste, et al. (2006)
• Australasian Malignant PLeural Effusion (AMPLE)-3 trial: study protocol for a multi-centre randomised study comparing indwelling pleural catheter (±talc pleurodesis) versus video-assisted thoracoscopic surgery for management of malignant pleural effusion — D.B. Fitzgerald, C. Sidhu, et al. (2022)
• MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial — C. Matthews, C. Freeman, et al. (2019)
• Should all patients who have mesothelioma diagnosed by video-assisted thoracoscopic surgery have their intervention sites irradiated? — M. Nagendran, A. Pallis, et al. (2011)
• The MesoVATS trial: is there a future for video-assisted thoracoscopic surgery partial pleurectomy? — R.C. Rintoul (2015)
• Video assisted thoracoscopic and open chest surgery in diagnosis and treatment of malignant pleural diseases — P. Perikleous, D.A. Waller (2017)

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