Thoracoscopic Talc Versus Tunneled Pleural Catheters for Palliation of Malignant Pleural Effusions

• Published in: The Annals of thoracic surgery Vol. 94; no. 4; pp. 1053 - 1059
• Main Authors: Hunt, Ben M., MD, Farivar, Alexander S., MD, Vallières, Eric, MD, Louie, Brian E., MD, Aye, Ralph W., MD, Flores, Eva E., LPN, Gorden, Jed A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2012; Elsevier
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Catheters; Drainage - instrumentation; Female; Follow-Up Studies; Hospital Mortality - trends; Humans; Insufflation - methods; Length of Stay - trends; Male; Medical sciences; Palliative Care - methods; Pleural Effusion, Malignant - diagnosis; Pleural Effusion, Malignant - mortality; Pleural Effusion, Malignant - therapy; Pleurodesis - methods; Pneumology; Retrospective Studies; Surgery; Survival Rate - trends; Talc - administration & dosage; Thoracic Surgery, Video-Assisted - methods; Treatment Outcome; Tumors of the respiratory system and mediastinum; Washington - epidemiology; Washington; 14; Talc; Catheter; Pleural disease; Anesthesia; Malignant tumor; Circulatory system; Cardiology; Malignant pleural effusion; Comparative study; Cancer; Tunnels
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.01.103

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.