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

BACKGROUND: Pericardiotomy for cancer patients with effusion can alleviate symptoms, but with unclear effect on long term survival. Our experience with VATS technique has produced some long-term survivors. METHODS: A retrospective review of 62 VATS pericardiotomy for pericardial effusion in patients with known malignancy. Kaplan-Meier survival curves and Log-Rank tests were used for analysis. RESULTS: The mean age was 54.8+/-14.3 years (ranging from 19 to 79). The mean hospital stay was 8.7+/-5.5 days. The median survival was 6.75 months (range 1 month-10 years). Overall one-year survival was 44.2%, 3-year survival 17.6%, and 5-year survival 10% after drainage of pericardial effusion. The mean survival in cytology negative patients (n=21) was 13.4+/-0.98 months, compared to 4.89+/-0.9 months in cytology positive patients (n=27) (p=0.0175). The 5-year survival in cytology negative patients was 19.6%, while none of the patients with positive cytology were alive after 36 months. The mean survival in patients with no evidence of metastatic disease on the pericardium (n=28) was 12.8+/-0.9 months, compared to patients with metastatic disease of the pericardium (n=22) 4.66+/-0.8 months (p=0.026). CONCLUSIONS: VATS Pericardiotomy can provide effective long-term drainage in patients with symptomatic pericardial effusion. Positive cytology and metastatic involvement of the pericardium are predictive of worse survival. Survival greater than 5 years can be expected in 19% and 17% of patients with negative fluid cytology and negative metastatic disease of the pericardium, respectively.