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Edward J Caruana
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P1.14 - Thymoma/Other Thoracic Malignancies (Not CME Accredited Session) (ID 946)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.14-01 - Current Practices in the Management of Malignant Pericardial Effusions: A Survey Amongst Members of the European Society of Thoracic Surgeons. (ID 14287)
16:45 - 18:00 | Presenting Author(s): Edward J Caruana
- Abstract
Background
Malignant pericardial effusion (MPE) is a rare presentation, is associated with a high morbidity and mortality, and may be challenging to manage.
We sought to determine the current practice in the management of MPE among members of the European Society of Thoracic Surgeons (ESTS).
a9ded1e5ce5d75814730bb4caaf49419 Method
A cross-sectional survey examining the case volume, initial workup, urgent and non-urgent management of MPE was developed by the authors, following a review of the literature. The survey was circulated to ESTS membership in an internet-based survey format, between February and April 2016.
4c3880bb027f159e801041b1021e88e8 Result
136 consultant thoracic surgical colleagues responded; representing 43 countries across 5 continents, and with an average (mean±SD) of 14±9 years’ independent practice. Annual volume of MPE referral was 9±12 cases (median, range = 5, 0 to 80).
Echocardiography (88%), computed tomography (85%) and pericardial fluid cytology (54%) are the preferred initial investigations.
In clinically stable patients, pericardiocentesis is the preferred (60%) intervention in first-presentations; with 80% of patients with recurrent effusions being offered pleuro-pericardial fenestration (66% thoracoscopically, 14% thoracotomy). 43 to 50% of respondents would use an intrapericardial sclerosant as part of their management of recurrent MPEs, depending on primary pathology.
The preferred approach options in patients with cardiac tamponade are ultrasound-guided pericardiocentesis (56%), subxiphoid pericardiotomy (26%) and landmark pericardiocentesis (11%).
Only 24% of respondents felt that their practice was informed by published clinical guidelines, with 53% expressing a need for updating of current guidance.
8eea62084ca7e541d918e823422bd82e Conclusion
There is much variation, and reported uncertainty, in the management of MPEs in clinical practice. There is, additionally, lack of engagement with currently-available clinical guidance.
6f8b794f3246b0c1e1780bb4d4d5dc53
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P2.06 - Mesothelioma (Not CME Accredited Session) (ID 955)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.06-04 - Throughput of a Specialist Mesothelioma Multidisciplinary Team Meeting at a Radical Treatment Centre in the United Kingdom. (ID 14195)
16:45 - 18:00 | Presenting Author(s): Edward J Caruana
- Abstract
Background
Multidisciplinary team (MDT) meetings are of particular value in cases where decision making is complicated by clinical equipoise. Patients should be actively considered for all established treatment and clinical trial options for which they are suitable.
a9ded1e5ce5d75814730bb4caaf49419 Method
A specialist regional mesothelioma MDT - involving physicians, radiologists, oncologists, surgeons, and allied health professionals - was established in 2013. Patients were considered for the full range from palliative to radical surgical treatment options, all of which are offered locally at our institution. Electronic records of MDT activity were retrospectively analysed.
4c3880bb027f159e801041b1021e88e8 Result
543 patients - 82% were male, average age 71±9 years - were discussed in our specialist MDT, between July 2013 and March 2017, with referrals from 50 hospitals from around the United Kingdom. 61% of patients were from outside the direct specialist referral (regional) catchment area. Patients were recommended for radical surgery (44%), chemotherapy or radiotherapy (36%), active symptom management (14%), or palliative care (6%). Average survival post MDT discussion was 8±6 months.
8eea62084ca7e541d918e823422bd82e Conclusion
A specialist regional mesothelioma MDT is invaluable in the context of patient throughput; and is valuable in determining treatment strategies. Its impact on survival and quality of life outcomes is still to be determined.
6f8b794f3246b0c1e1780bb4d4d5dc53
