Cancer and Pericardiocentesis for Pericardial Effusion

Study Questions:

What are the outcomes associated with pericardiocentesis for pericardial effusion among patients with cancer?

Methods:

Patients who underwent percutaneous pericardiocentesis for pericardial effusion between November 2009 and October 2014 at a single large referral center for cancer were included in the analysis. Procedure-related complications, effusion recurrence rate, and overall survival were analyzed.

Results:

Of 1,645 patients with cancer referred for pericardial effusion, 212 (13%) underwent percutaneous pericardiocentesis. The procedure was successful in 210 (99% of cases), and there were no procedure-related deaths. There were four patients who had procedure-related bleeding, but bleeding did not vary based on platelet count <50,000 /µL vs. ≥50,000 /µL (p = 0.13). Patients with catheter drainage of the effusion for 3-5 days had the lowest rate of recurrence (10%). Median overall survival was 143 days; lung cancer, platelet count <20,000 /µL, and malignant pericardial effusion were independently associated with a poor prognosis. Patients with lung cancer and proven malignant pericardial effusion had significantly worse 1-year survival compared to those with nonmalignant effusion (16.2% vs. 49.0%, log-rank test p value = 0.01). A similar 1-year survival was not observed among patients with breast cancer (40.2% vs. 40.0%, log-rank test p = 0.42).

Conclusions:

Among patients with cancer, percutaneous pericardiocentesis with extended catheter drainage is safe and effective as a primary treatment for pericardial effusion, including patients with thrombocytopenia. Malignant pericardial effusion is associated with a significantly shortened survival among patients with lung cancer, but not among patients with breast cancer.

Perspective:

There are limited data regarding various treatment options for pericardial effusion among patients with cancer. Although some data support a high success rate and low rate of recurrence associated with surgical intervention (pericardial window, pericardio-peritoneal shunt, pericardiectomy) or with sclerosing agents, they also can be associated with significant rates of complications. These data support the use of percutaneous pericardiocentesis with extended catheter drainage among patients with cancer and pericardial effusion, including patients with thrombocytopenia.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Pericardial Disease

Keywords: Breast Neoplasms, Lung Neoplasms, Cardiac Surgical Procedures, Catheters, Drainage, Neoplasm Recurrence, Local, Pericardial Effusion, Pericardiectomy, Pericardiocentesis, Thrombocytopenia


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