Original article
General thoracic
Thoracoscopic Talc Versus Tunneled Pleural Catheters for Palliation of Malignant Pleural Effusions

Presented at the Fifty-eighth Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 9–12, 2011.
https://doi.org/10.1016/j.athoracsur.2012.01.103Get rights and content

Background

A malignant pleural effusion (MPE) is a late complication of malignancy that affects respiratory function and quality of life. A strategy for palliation of the symptoms caused by MPE should permanently control fluid accumulation, preclude any need for reintervention, and limit hospital length of stay (LOS). We compared video-assisted thorascopic (VATS) talc insufflation with placement of a tunneled pleural catheter (TPC) to assess which intervention better met these palliative goals.

Methods

We conducted a retrospective chart review of consecutive MPE at a single institution from 2005 through June 2011. Primary a priori outcomes were reintervention in the ipsilateral hemithorax, postprocedure LOS, and overall LOS.

Results

One hundred nine patients with MPE were identified. Fifty-nine patients (54%) had TPC placed, and 50 (46%) were treated with VATS talc. Patients who underwent TPC placement had significantly fewer reinterventions for recurrent ipsilateral effusions than patients treated with VATS talc (TPC 2% [1 of 59], talc 16% [8 of 50], p = 0.01). Patients treated with TPC had significantly shorter overall LOS (TPC LOS mean 7 days, mode 1 day; talc mean 8 day, mode 4 days, p = 0.006) and postprocedure LOS (TPC post-procedure LOS mean 3 days, mode 0 days; talc mean 6 days, mode 3 days, p < 0.001). Type of procedure was not associated with differences in complication rate (TPC 5% [3 of 59], talc 14% [7 of 50], p = 0.18), or in-hospital mortality (TPC 3% [2 of 59], talc 8% [4 of 50], p = 0.41).

Conclusions

TPC placement was associated with a significantly reduced postprocedure and overall LOS compared with VATS talc. Also, TPC placement was associated with significantly fewer ipsilateral reinterventions. Placement of TPC should be considered for palliation of MPE-associated symptoms.

Section snippets

Patients and Methods

A retrospective chart review was performed at a single institution from 2005 to June 2011. Patients were identified by a database query for International Classification of Diseases, Ninth Revision codes for VATS with pleurodesis (32650), TPC placement (32550), and chemical pleurodesis (32560). Because bedside pleurodesis by talc slurry is usually performed by residents without an attending present at our institution, bedside pleurodesis was not billable and was not identified by our query.

Results

One hundred nine consecutive patients with MPE were identified; TPCs were placed in 59 of 109 patients (54%), and 50 of 109 patients (46%) underwent VATS talc pleurodesis. Of the TPCs, 47 of 59 (80%) were placed using conscious sedation by the Seldinger technique, and 12 of 59 (20%) were placed during VATS. All talc pleurodeses in this series were done by VATS. One VATS talc case was converted to open to control bleeding from pleural biopsies (2% conversion rate). Patient demographics and

Comment

Malignant pleural effusion significantly affects patient quality of life [1, 2]. Currently, several options exist for the treatment of MPE (Table 3). Most published guidelines for management of MPE begin with a recommendation for thoracentesis, which provides diagnostic and therapeutic value [1, 7, 13, 14]. Thoracentesis evaluates lung entrapment and whether symptoms are relieved by draining the effusion. Both are critical branch points when evaluating future palliative options [7].

If the MPE

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