Predictors of Recurrence and Survival in Cancer Patients With Pericardial Effusion Requiring Pericardiocentesis

Complications in Pericardiocentesis: Right Ventricular Perforation in a 75-Year-Old Patient with Lymphoma

BACKGROUND Pericardiocentesis is a commonly used procedure to remove or sample pericardial effusion, and complications of this procedure are rare. This report describes a 75-year-old man with lymphoma and right ventricular perforation during pericardiocentesis for pericardial effusion. CASE REPORT A 75-year-old male patient with diffuse large B cell lymphoma was admitted with concerns of refractory chest tightness and breath shortness after physical exercise. Images from echocardiography showed massive pericardial effusion. After a comprehensive clinical assessment, pericardiocentesis was selected as the corresponding strategy, with the aim to improve the symptom of pericardial compression. However, during the procedure, it was found that the catheter was not placed into the expected location, and the right ventricle was damaged by inappropriate puncture, which led to hemopericardium. Computed tomography showed a high-density 2-mm suspected foreign body penetrating from the pericardial cavity, right ventricle to pulmonary main artery. At the same time, echocardiography showed that cardiac compression was more severe from the progressive effusion and continuous clot formation, which could lead to tamponade or even sudden cardiac arrest. Therefore, this patient immediately underwent emergent exploratory thoracotomy to drain the hemopericardium and remove the misplaced catheter, as well as to repair the damaged right ventricle. CONCLUSIONS Pericardiocentesis has risks due to the invasiveness of the procedure; hence, it is important to conduct complete and comprehensive assessments and preparations before the procedure. Once related complications are found, earlier and effective intervention, including emergent surgery, should be necessary.

Pericardiocentesis versus window formation in malignant pericardial effusion: trends and outcomes

OBJECTIVES

Malignant pericardial effusion (MPE) in patients with cancer is associated with poor prognosis. This study aimed to compare clinical outcomes in patients with cancer who underwent pericardiocentesis versus pericardial window formation.

METHODS

In the present study, 765 consecutive patients with cancer (mean age 58.4 years, 395 men) who underwent pericardial drainage between 2003 and 2022 were retrospectively analysed. All-cause death and MPE recurrence were compared based on the drainage method (pericardiocentesis vs pericardial window formation) and time period (period 1: 2003-2012; period 2: 2013-2022).

RESULTS

Pericardiocentesis was performed in 639 (83.5%) patients and pericardial window formation in 126 (16.5%). There was no difference in age, sex distribution, proportion of metastatic or relapsed cancer, and chemotherapy status between the pericardiocentesis and pericardial window formation groups. Difference was not found in all-cause death between the two groups (log-rank p=0.226) regardless of the period. The pericardial window formation group was associated with lower MPE recurrence than the pericardiocentesis group (6.3% vs 18.0%, log-rank p=0.001). This advantage of pericardial window formation was more significant in period 2 (18.1% vs 1.3%, log-rank p=0.005). In multivariate analysis, pericardial window formation was associated with lower MPE recurrence (HR: 0.31, 95% CI: 0.15 to 0.63, p=0.001); younger age, metastatic or relapsed cancer, and positive malignant cells in pericardial fluid were associated with increased recurrence.

CONCLUSION

In patients undergoing pericardial drainage for MPE, pericardial window formation showed mortality outcomes comparable with pericardiocentesis and was associated with lower incidence of MPE recurrence.

Management of Pericardial Effusion in Patients With Solid Tumor: An Algorithmic, Multidisciplinary Approach Results in Reduced Mortality After Paradoxical Hemodynamic Instability

OBJECTIVE

This study compared outcomes in patients with solid tumor treated for pericardial effusion with surgical drainage versus interventional radiology (IR) percutaneous drainage and compared incidence of paradoxical hemodynamic instability (PHI) between cohorts.

BACKGROUND

Patients with advanced-stage solid malignancies may develop large pericardial effusions requiring intervention. PHI is a fatal and underreported complication that occurs following pericardial effusion drainage.

METHODS

Clinical characteristics and outcomes were compared between patients with solid tumors who underwent s urgical drainage or IR percutaneous drainage for pericardial effusion from 2010 to 2020.

RESULTS

Among 447 patients, 243 were treated with surgical drainage, of which 27 (11%) developed PHI, compared with 7 of 204 patients (3%) who were treated with IR percutaneous drainage ( P =0.002); overall incidence of PHI decreased during the study period. Rates of reintervention (30-day: 1% vs 4%; 90-day: 4% vs 6%, P =0.7) and mortality (30-day: 21% vs 17%, P =0.3; 90-day: 39% vs 37%, P =0.7) were not different between patients treated with surgical drainage and IR percutaneous drainage. For both interventions, OS was shorter among patients with PHI than among patients without PHI (surgical drainage, median [95% confidence interval] OS, 0.89 mo [0.33-2.1] vs 6.5 mo [5.0-8.9], P <0.001; IR percutaneous drainage, 3.7 mo [0.23-6.8] vs 5.0 mo [4.0-8.1], P =0.044).

CONCLUSIONS

With a coordinated multidisciplinary approach focusing on prompt clinical and echocardiographic evaluation, triage with bias toward IR percutaneous drainage than surgical drainage and postintervention intensive care resulted in lower incidence of PHI and improved outcomes.

Lung Cancer Supportive Care and Symptom Management

Lung cancer carries significant mortality and morbidity. In addition to treatment advances, supportive care may provide significant benefit for patients and their caregivers. A multidisciplinary approach is critical in addressing complications of lung cancer, including disease- and treatment-related complications, oncologic emergencies, symptom management and supportive care, and addressing the psychosocial needs of affected patients.