Management of Malignant Pleural Effusion
 
For purposes of this survey, assume that you are asked to consult on a hospitalized middle-aged patient who has been diagnosed with stage IV non-small cell lung cancer. The patient has shortness of breath in the presence of an important unilateral pleural effusion. There is no endobronchial obstruction and there is no evidence for pulmonary embolism. A CT scan demonstrates a large uniloculated unilateral effusion. A diagnostic thoracentesis demonstrates malignant cells in the pleural fluid. No attempt has been made to completely drain the fluid.

1. Do you manage patients with malignant pleural effusion?

2. When do you believe definitive management of this effusion is appropriate?

3. In your institution, which specialist is most commonly consulted first for this problem?

4. What is your preferred method for definitively managing this effusion?

5. If you perform chemical pleural sclerosis, what substance do you use to accomplish this?

6. If you perform sclerosis, for how long do you drain the pleural space afterwards?

7. Does the degree of symptoms reported by the patient influence your choice of surgical intervention for such effusions?

8. In what region is your surgical practice based?