Cardiac tamponade caused by primary lung cancer and the management of pericardial effusion.

Abstract

Between 1978 and 1990, 51 cases of pericardial effusion secondary to lung cancer were treated at the National Cancer Center Hospital by creating a pericardial window, using the subxiphoid approach, that was connected to a water-sealed drainage system. Most patients had advanced disease, such as distant metastasis (76%), pleural effusion (88%), and clinical Stage N2 or N3 disease (98%). Forty-five patients had cardiac tamponade, and six had no symptoms attributable to pericardial effusion. Cardiac tamponade was the initial manifestation of lung cancer in only 3 patients; it was a late manifestation in 48. Of those specimens that were examined cytologically, 92% had positive findings. The interval from creation of the pericardial window until removal of the drainage tube ranged from 4-135 days (median, 11 days). The interval was significantly longer in patients who previously had received thoracic radiation therapy (P < 0.05). The overall median survival was 80 days, and the 1-year survival rate was 10.5%. Postmortem examination showed that constrictive heart failure caused by pericardial lesions was the major contributory cause of death in 32% of patients. Using multivariate analysis, factors indicating a poor prognosis were: (1) the interval from the diagnosis of lung cancer to pericardial effusion development (P = 0.005) and (2) the absence of prior surgery (P = 0.007). The creation of a pericardial window effectively treated pericardial effusion in 85% of cases. However, the role of intrapericardial instillation of anticancer or sclerosing agents was unclear in this retrospective analysis.