Various Treatment Modalities in Hepatic Hydrothorax: What Is Safe and Effective?
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Purpose: Hepatic hydrothorax is a complication of decompensated liver cirrhosis that is difficult and complex to manage. Dataconcerning the optimal treatment method, other than liver transplantation, are limited. This study aimed to compare the clinicalfeatures and outcomes of patients treated with various modalities, while focusing on surgical management and pigtail drainage. Materials and Methods: Forty-one patients diagnosed with refractory hepatic hydrothorax between January 2013 and December2017 were enrolled. Results: The mean Child-Turcotte-Pugh and model for end stage liver disease scores of the enrolled patients were 10.1 and 19.7,respectively. The patients underwent four modalities: serial thoracentesis (n=11, 26.8%), pigtail drainage (n=16, 39.0%), surgery(n=10, 24.4%), and liver transplantation (n=4, 9.8%); 12-month mortality rate/median survival duration was 18.2%/868 days,87.5%/79 days, 70%/179 days, and 0%/601.5 days, respectively. Regarding the management of refractory hepatic hydrothorax,surgery group required less frequent needle puncture (23.5 times in pigtail group vs. 9.3 times in surgery group), had a lower occurrenceof hepatorenal syndrome (50% vs. 30%), and had a non-inferior cumulative overall survival (402.1 days vs. 221.7 days)compared to pigtail group. On multivariate analysis for poor survival, body mass index <19 kg/m2, refractory hepatic hydrothoraxnot managed with liver transplantation, Child-Turcotte-Pugh score >10, and history of severe encephalopathy (grade >2) were associatedwith poor survival. Conclusion: Serial thoracentesis may be recommended for management of hepatic hydrothorax and surgical management canbe a useful option in patients with refractory hepatic hydrothorax, alternative to pigtail drainage.
Abstract
Purpose: Hepatic hydrothorax is a complication of decompensated liver cirrhosis that is difficult and complex to manage. Dataconcerning the optimal treatment method, other than liver transplantation, are limited. This study aimed to compare the clinicalfeatures and outcomes of patients treated with various modalities, while focusing on surgical management and pigtail drainage. Materials and Methods: Forty-one patients diagnosed with refractory hepatic hydrothorax between January 2013 and December2017 were enrolled. Results: The mean Child-Turcotte-Pugh and model for end stage liver disease scores of the enrolled patients were 10.1 and 19.7,respectively. The patients underwent four modalities: serial thoracentesis (n=11, 26.8%), pigtail drainage (n=16, 39.0%), surgery(n=10, 24.4%), and liver transplantation (n=4, 9.8%); 12-month mortality rate/median survival duration was 18.2%/868 days,87.5%/79 days, 70%/179 days, and 0%/601.5 days, respectively. Regarding the management of refractory hepatic hydrothorax,surgery group required less frequent needle puncture (23.5 times in pigtail group vs. 9.3 times in surgery group), had a lower occurrenceof hepatorenal syndrome (50% vs. 30%), and had a non-inferior cumulative overall survival (402.1 days vs. 221.7 days)compared to pigtail group. On multivariate analysis for poor survival, body mass index <19 kg/m2, refractory hepatic hydrothoraxnot managed with liver transplantation, Child-Turcotte-Pugh score >10, and history of severe encephalopathy (grade >2) were associatedwith poor survival. Conclusion: Serial thoracentesis may be recommended for management of hepatic hydrothorax and surgical management canbe a useful option in patients with refractory hepatic hydrothorax, alternative to pigtail drainage.
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