Original article
General thoracic
Who Gains Most? A 10-Year Experience With 611 Thoracoscopic Talc Pleurodeses

https://doi.org/10.1016/j.athoracsur.2007.02.061Get rights and content

Background

Thoracoscopic talc pleurodesis is a therapeutic option for recurrent pleural effusion.

Methods

This retrospective study included 611 patients who underwent thoracoscopic talc pleurodesis between 1994 and 2003. We analyzed the risk factors, efficiency, outcome, follow-up, and survival, while taking into consideration primary disease and general condition.

Results

The mean follow-up was 319 days (range, 31 to 1994). A total of 105 (17.2%) of 611 patients died within 30 days after treatment. Risk factors for death within 30 days included a Karnofsky index of less than 50%, a body mass index of less than 25 kg/m2, malignant disease, and male gender. Treatment was successful in 347 (68.6%) of 506 patients, and 451 (89.1%) reported an improvement in symptoms. Previous thoracic irradiation and a chest tube drainage time exceeding 10 days negatively influenced the outcome of pleurodesis. The survival rate was negatively influenced by a preoperative Karnofsky index of less than 60% and by malignant disease.

Conclusions

Patients with pleural effusion due to malignant disease gain from early pleurodesis. The most favorable outcome after talc pleurodesis was seen in women whose lungs were fully expandable, in patients whose Karnofsky index exceeded 60%, in patients whose body mass index was greater than 25 kg/m2, and in patients with benign disease.

Section snippets

Patients and Methods

The study was approved by the Ethics Committee of the University of Tübingen. According to the Ethics Committee, individual consent was not necessary because of the study’s retrospective design.

Study Population

A total of 611 patients (295 women, 316 men) with one-sided pleural effusion received thoracoscopic talc pleurodesis. Of these, 543 patients (88.9%) had malignant disease. After talc pleurodesis, 492 (80.5%) had a fully expanded lung, 451 (89.1%) had improvement in symptoms, and a recurrent pleural effusion developed in 135 (22.1%). A total of 105 patients (20.7%) died within the first 30 postoperative days, and 347 (68.6%) had a successful pleurodesis according to the criteria mentioned above.

Comment

Malignancy is the most common cause of pleural effusion. The estimated number of patients with malignant pleural effusion may be as high as 100 per 100,000 population. This high incidence makes malignant pleural effusion a serious problem for health care institutions. Curative treatment in metastatic disease is usually impossible when the pleura are involved; thus, the goal of treatment for these patients is improvement in symptoms that worsen the quality of life.

Several methods have been

References (45)

  • A.H. Diacon et al.

    Prospective randomized comparison of thoracoscopic talc poudrage under local anesthesia versus bleomycin instillation for pleurodesis in malignant pleural effusions

    Am J Respir Crit Care Med

    (2000)
  • M.A. Bresticker et al.

    Optimal pleurodesis: a comparison study

    Ann Thorac Surg

    (1993)
  • D.A. Karnofsky et al.

    The use of the nitrogen mustards in the palliative treatment of carcinomaWith particular reference to bronchogenic carcinoma

    Cancer

    (1948)
  • E.M. Marom et al.

    Malignant pleural effusions: treatment with small-bore-catheter thoracostomy and talc pleurodesis

    Radiology

    (1999)
  • W.C. Su et al.

    Combined intrapleural and intravenous chemotherapy, and pulmonary irradiation, for treatment of patients with lung cancer presenting with malignant pleural effusionA pilot study

    Oncology

    (2003)
  • F.J. Haddad et al.

    Pleurodesis in patients with malignant pleural effusions: talc slurry or bleomycin? Results of a prospective randomized trial

    World J Surg

    (2004)
  • D.A. Waller

    The role of surgery in diagnosis and treatment of malignant pleural mesothelioma

    Curr Opin Oncol

    (2003)
  • S. Sartori et al.

    Prospective randomized trial of intrapleural bleomycin versus interferon alfa-2b via ultrasound-guided small-bore chest tube in the palliative treatment of malignant pleural effusions

    J Clin Oncol

    (2004)
  • D.S. Cheng et al.

    The effects of intrapleural polyclonal anti-tumor necrosis factor alpha (TNF alpha) Fab fragments on pleurodesis in rabbits

    Lung

    (2000)
  • Y.C. Lee et al.

    Comparing transforming growth factor-beta2, talc and bleomycin as pleurodesing agents in sheep

    Respirology

    (2002)
  • N. Bethune

    Pleural poudrage

    J Thoracic Surgery

    (1934)
  • M.H. Baumann et al.

    Pleural macrophages differentially alter mesothelial cell growth and collagen production

    Inflammation

    (1993)
  • Cited by (56)

    • Gender Disparity in Referral for Definitive Care of Malignant Pleural Effusions

      2019, Journal of Surgical Research
      Citation Excerpt :

      Although it is concerning that women receive lower referral rates than men, it is striking that our and other studies suggest that they are likely the group that would benefit the most from thoracic surgery referral. Our findings that women had longer life expectancy than men support several other studies, which show improved survival in patients with ovarian and breast cancers, exclusively and primarily female cancers, respectively.16,24,26 A large study of all US MPE admissions shows decreased inpatient mortality among women with MPE.14

    • Malignancy-Related Effusions

      2019, Abeloff’s Clinical Oncology
    • Diagnosis and Management of Pleural Transudates

      2017, Archivos de Bronconeumologia
    • Malignant Effusions

      2013, Abeloff's Clinical Oncology: Fifth Edition
    • Bilateral transudative effusions

      2023, Challenging Cases in Pleural Diseases
    View all citing articles on Scopus
    View full text