Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Pericardial Window Operation in Oncology Patients: Analysis of Long-Term Survival and Prognostic Factors

  • Sung Min Kim (Department of Cardiovascular and Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jun Ho Lee (Department of Cardiovascular and Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Su Ryeun Chung (Department of Cardiovascular and Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kiick Sung (Department of Cardiovascular and Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Wook Sung Kim (Department of Cardiovascular and Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yang Hyun Cho (Department of Cardiovascular and Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2023.08.16
  • Accepted : 2023.11.28
  • Published : 2024.03.05
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Abstract

Background: Pericardial effusion (PE) is a serious condition in cancer patients, primarily arising from malignant dissemination. Pericardial window formation is a surgical intervention for refractory PE. However, the long-term outcomes and factors associated with postoperative survival remain unclear. Methods: We retrospectively analyzed data from 166 oncology patients who underwent pericardial window formation at Samsung Medical Center between 2011 and 2023. We analyzed survival and PE recurrence regarding surgical approach, cancer type, and cytopathological findings. To identify factors associated with survival, we utilized Cox proportional-hazards regression. Results: All patients had tumors documented in accordance with the American Joint Committee on Cancer staging manual, including lung (61.4%), breast (9.6%), gastrointestinal (9.0%), hematologic (3.6%), and other cancers (16.4%). Surgical approaches included mini-thoracotomy (67.5%) and thoracoscopy (32.5%). Postsurgical cytopathology confirmed malignancy in 94 cases (56.6%). Over a median follow-up duration of 50.0 months, 142 deaths and 16 PE recurrences occurred. The 1-year overall and PE recurrence-free survival rates were 31.4% and 28.6%, respectively. One-year survival rates were significantly higher for thoracoscopy recipients (43.7% vs. 25.6%, p=0.031) and patients with negative cytopathology results (45.1% vs. 20.6%, p<0.001). No significant survival difference was observed between lung cancer and other types (p=0.129). Multivariate analysis identified New York Heart Association class, cancer stage, and cytopathology as independent prognostic factors. Conclusion: This series is the largest to date concerning window formation among cancer patients with PE. Patients' long-term survival after surgery was generally unfavorable. However, cases with negative cytopathology or earlier tumor stage demonstrated comparatively high survival rates.

Keywords

Acknowledgement

This work was supported by a grant from the Korea Medical Device Development Fund, financed by the Korean government (including the Ministry of Science and ICT; the Ministry of Trade, Industry and Energy; the Ministry of Health & Welfare; and the Ministry of Food and Drug Safety) (Project no., 1711138313, KMDF_PR_20200901_0159).

References

  1. Neragi-Miandoab S, Linden PA, Ducko CT, et al. VATS pericardiotomy for patients with known malignancy and pericardial effusion: survival and prognosis of positive cytology and metastatic involvement of the pericardium: a case control study. Int J Surg 2008;6:110-4. https://doi.org/10.1016/j.ijsu.2007.12.005
  2. Bisel HF, Wroblewski F, Ladue JS. Incidence and clinical manifestations of cardiac metastases. J Am Med Assoc 1953;153:712-5. https://doi.org/10.1001/jama.1953.02940250018005
  3. Theologides A. Neoplastic cardiac tamponade. Semin Oncol 1978;5:181-92.
  4. Okamoto H, Shinkai T, Yamakido M, Saijo N. Cardiac tamponade caused by primary lung cancer and the management of pericardial effusion. Cancer 1993;71:93-8. https://doi.org/10.1002/1097-0142(19930101)71:1<93::aid-cncr2820710115>3.0.co;2-r
  5. Hankins JR, Satterfield JR, Aisner J, Wiernik PH, McLaughlin JS. Pericardial window for malignant pericardial effusion. Ann Thorac Surg 1980;30:465-71. https://doi.org/10.1016/s0003-4975(10)61298-2
  6. Celermajer DS, Boyer MJ, Bailey BP, Tattersall MH. Pericardiocentesis for symptomatic malignant pericardial effusion: a study of 36 patients. Med J Aust 1991;154:19-22. https://doi.org/10.5694/j.1326-5377.1991.tb112840.x
  7. O'Brien PK, Kucharczuk JC, Marshall MB, et al. Comparative study of subxiphoid versus video-thoracoscopic pericardial "window". Ann Thorac Surg 2005;80:2013-9. https://doi.org/10.1016/j.athoracsur.2005.05.059
  8. Cullinane CA, Paz IB, Smith D, Carter N, Grannis FW Jr. Prognostic factors in the surgical management of pericardial effusion in the patient with concurrent malignancy. Chest 2004;125:1328-34. https:// doi.org/10.1378/chest.125.4.1328
  9. Celik S, Celik M, Aydemir B, Tanrikulu H, Okay T, Tanrikulu N. Surgical properties and survival of a pericardial window via left minithoracotomy for benign and malignant pericardial tamponade in cancer patients. World J Surg Oncol 2012;10:123. https://doi.org/10.1186/1477-7819-10-123
  10. Laham RJ, Cohen DJ, Kuntz RE, Baim DS, Lorell BH, Simons M. Pericardial effusion in patients with cancer: outcome with contemporary management strategies. Heart 1996;75:67-71. https://doi.org/10.1136/hrt.75.1.67
  11. Sakanoue I, Hamakawa H, Okubo Y, et al. Efficacy and safety of thoracoscopic pericardial window in patients with pericardial effusions: a single-center case series. J Cardiothorac Surg 2016;11:92. https://doi.org/10.1186/s13019-016-0488-x
  12. Jeon HW, Cho DG, Park JK, et al. Prognostic factors affecting survival of patients with cancer-related pericardial effusion managed by surgery. World J Surg Oncol 2014;12:249. https://doi.org/10.1186/1477-7819-12-249
  13. Gornik HL, Gerhard-Herman M, Beckman JA. Abnormal cytology predicts poor prognosis in cancer patients with pericardial effusion. J Clin Oncol 2005;23:5211-6. https://doi.org/10.1200/JCO.2005.00.745
  14. Olsen PS, Sorensen C, Andersen HO. Surgical treatment of large pericardial effusions. Etiology and long-term survival. Eur J Cardiothorac Surg 1991;5:430-2. https://doi.org/10.1016/1010-7940(91)90189-q
  15. Porte HL, Janecki-Delebecq TJ, Finzi L, Metois DG, Millaire A, Wurtz AJ. Pericardoscopy for primary management of pericardial effusion in cancer patients. Eur J Cardiothorac Surg 1999;16:287-91. https://doi.org/10.1016/s1010-7940(99)00204-3
  16. Ucche M, Putra A, Gustisiya MA, Choridah L, Supriatna Y, Dwidanarti SR, et al. Remarkable response to pericardial window procedure and weekly docetaxel treatment in a metastatic breast cancer patient with pericardial effusion and cardiac tamponade. Clin Case Rep 2020;8:3178-83. https://doi.org/10.1002/ccr3.3380
  17. Celik S, Lestuzzi C, Cervesato E, et al. Systemic chemotherapy in combination with pericardial window has better outcomes in malignant pericardial effusions. J Thorac Cardiovasc Surg 2014;148:2288-93. https://doi.org/10.1016/j.jtcvs.2014.04.031
  18. Tsang TS, Seward JB, Barnes ME, et al. Outcomes of primary and secondary treatment of pericardial effusion in patients with malignancy. Mayo Clin Proc 2000;75:248-53. https://doi.org/10.4065/75.3.248
  19. Wagner PL, McAleer E, Stillwell E, et al. Pericardial effusions in the cancer population: prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability. J Thorac Cardiovasc Surg 2011;141:34-8. https://doi.org/10.1016/j.jtcvs.2010.09.015
  20. DeCamp MM Jr, Mentzer SJ, Swanson SJ, Sugarbaker DJ. Malignant effusive disease of the pleura and pericardium. Chest 1997;112(4 Suppl):291S-295S. https://doi.org/10.1378/chest.112.4_supplement.291s