Talc slurry versus thoracoscopic talc insufflation for malignant pleural effusion: a systematic review and meta-analysis

• Published in: Jornal brasileiro de pneumologia Vol. 50; no. 3; p. e20240115
• Main Authors: Rodrigues, Anna Luíza Soares de Oliveira, Souza, Maria Eduarda Cavalcanti, Moraes, Francisco Cezar Aquino de, Lima, David Paes de, Carvalho, Rafael Lucas Costa de
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Pneumologia e Tisiologia 2024
• Subjects: Humans; Insufflation - adverse effects; Insufflation - methods; Pleural effusion, malignant; Pleural Effusion, Malignant - therapy; Pleurodesis; Pleurodesis - methods; Reproducibility of Results; RESPIRATORY SYSTEM; Systematic Review and Meta-Analysis; Talc; Talc - administration & dosage; Thoracoscopy - adverse effects; Thoracoscopy - methods; Treatment Outcome; Pleural effusion, malignant; Pleurodesis; Talc
• ISSN: 1806-3756; 1806-3713; 1806-3756
• DOI: 10.36416/1806-3756/e20240115

Talc pleurodesis is a widely used treatment option for malignant pleural effusion (MPE). However, the optimal form of administration remains controversial. Thus, we performed a systematic review and meta-analysis to assess the effectiveness of talc slurry (TS) in comparison with thoracoscopic talc insufflation/poudrage (TTI) for MPE treatment. We searched PubMed, EMBASE, and Cochrane Library databases for studies that compared TS with TTI in patients with MPE. We used a random-effects model with a 95% CI to pool the data. Heterogeneity was assessed with I2 statistics. We included eight studies involving 1,163 patients, 584 of whom (50.21%) underwent TS. Pleurodesis failure rates were similar between the procedures (OR = 1.07; 95% CI: 0.56-2.06; p = 0.83; I2 = 62%); and 68% of patients (95% CI: 0.31-1.47; p = 0.33; I2 = 58%) had postoperative complications, which were lower in patients in the TS group than in the TTI group. In a subgroup analysis considering only randomized clinical trials, the failure rate was significantly lower in the TS treatment group (OR = 0.62; 95% CI: 0.42-0.90; p = 0.01; I2 = 0%). Similarly, dyspnea was less common in the TS group (OR = 0.74; 95% CI: 0.41-1.34; p = 0.32; I2 = 55%). Adverse effects were reported in 86 patients, and no significant difference was seen between the TS and TTI groups: empyema (OR = 1.43; 95% CI: 0.36-5.64; p = 0.86; I2 = 0%), pain (OR = 1.22 (95% CI: 0.67-2.21; p = 0.51; I2 = 38%), and pneumonia (OR = 1.15; 95% CI: 0.30-4.46; p = 0.86; I2 = 27%). Our findings suggest that TS is an effective treatment for MPE, with no significant increase in adverse events. Results suggest equivalent efficacy and safety for both procedures.