Original articleGeneral thoracicThoracoscopic Talc Versus Tunneled Pleural Catheters for Palliation of Malignant Pleural Effusions
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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