Effectiveness of Video-Assisted Thoracoscopic Surgery in Undiagnosed Exudative Pleural Effusions

Abstract

OBJECTIVES: Undiagnosed pleural effusions mostly require histologic studies for a definite diagnosis. In addition, malignant pleuraleffusions responsible for a significant part of exudative pleurisy need palliative therapy The purpose of our study is to research the effectiveness of video-assisted thoracoscopic surgery in definitive diagnosis and palliative treatment of unexplained non-parapneumonicexudative pleural effusions.MATERIALS AND METHODS: The study included 263 patients with non-parapneumonic exudative pleurisy, which could not be diagnosed by an initial clinical, radiological, biochemical, microbiological, and cytological investigation in three centers. All patientsunderwent video-assisted thoracoscopic surgery for definitive diagnosis between January 2002 and January 2018. Patients’ data wereretrospectively analyzed in terms of age, gender, symptoms, previously diagnosed cancers, computerized tomography of chest findings,histopathological diagnosis, cytological diagnosis, morbidity, mortality, and success rates of the procedure. Patient groups from the threecenters were divided into three groups according to the center of the patient. The groups were compared statistically in terms of cytologicdiagnosis rates.RESULTS: The most common complaint was dysnea (66.5%). Of the 263 cases, 83 were previously diagnosed with cancer. The simplepleural effusion (66.5%) was the most frequent radiological finding. The success rate for definitive diagnosis was detected as 97%. Ofall the cases, the rate of specific cytological diagnosis was detected to be 34%. The cytologic diagnosis rate was meaningfully lower inGroup 1than in Groups2 and 3. The postoperative morbidity rate was detected as 9%.CONCLUSION: Video-assisted thoracic surgery is not only a rapid and effective diagnostic method, but also a palliative therapeuticmethod. We think that it should be used immediately after initial diagnostic thoracentesis in undiagnosed exudative PEin the less experienced centers.