Ambulatory Thoracoscopic Pleurodesis Combined With Indwelling Pleural Catheter in Malignant Pleural Effusion

Abstract

Background and Objective: Malignant pleural effusion (MPE) often results in debilitating symptoms. Relief of dyspnoea and improvement in quality of life can be achieved with either talc pleurodesis or insertion of an indwelling tunneled pleural catheter (IPC). The former requires a lengthy hospital stay and the latter is associated with lower pleurodesis rates. In response to limited hospital bed capacity, we developed a pragmatic approach in managing MPE by combining thoracoscopic talc poudrage and insertion of IPC into a single day case procedure. We present data on the safety and efficacy of this approach.Methods: Patients who had undergone the abovementioned procedure between 2017 and 2020 were analyzed. Demographic data, hospital length of stay (LOS), histological diagnosis, rates of pleurodesis success and procedural related complications were collated. Patients were followed-up for 6 months.Results: Forty-five patients underwent the procedure. Mean age was 68.5 ± 10.4 years and 56% were male. Histological diagnosis was achieved in all cases. 86.7% of patients were discharged on the day of the procedure. Median LOS was 0 (IQR 0–0) days. Successful pleurodesis was attained in 77.8% at 6-month follow-up. No procedure related deaths or IPC related infections were recorded.Conclusion: Ambulatory thoracoscopic poudrage and IPC insertion is a safe and effective option in the management of MPE. All patients received a definitive pleural intervention with 77.8% pleurodesis success at 6-months and majority of them discharged on the same day. Future randomized trials are required to confirm these findings.

Local Anaesthetic Thoracoscopy for Pleural Effusion—A Narrative Review

“…There has been a palpable shift, evidenced by case series [ 58 ], towards day case LAT with indwelling pleural catheter (IPC) insertion in the last few months, which has been bolstered by the pleural guidance written by the British Thoracic Society at the start of the COVID-19 pandemic [ 59 ]. A trial is underway in the United Kingdom looking at the merits of day case LAT with IPC insertion (and aggressive subsequent drainage via the IPC) versus standard care (large bore drain, pleurodesis and admission) [ 60 ].…”

Diagnose und Management von malignem Pleuraerguss: Ein Jahrzehnt im Rückblick

“…In einer kürzlich veröffentlichten, retrospektiven, kartenbasierten Studie wurde festgestellt, dass die ambulante thorakoskopische Talkumpuderverabreichung und das Einsetzen eines IPC eine sichere und effektive Option für die Behandlung von MPE sind. 86,7% der Patienten konnten am Tag des Eingriffs entlassen werden, und die Pleurodeserate lag nach 6 Monaten bei 77,8% [91]. Eine multizentrische, randomisierte, kontrollierte Studie (TACTIC), in der Thorakoskopie, Talkumpuder und IPC mit ambulanter Behandlung im Vergleich zu Thorakoskopie und Talkumpuder mit Aufnahme für eine Thoraxdrainage verglichen werden, sollte bald mit der Rekrutierung beginnen [92].…”

Diagnostic value and safety of medical thoracoscopy in undiagnosed pleural effusions—a prospective observational cohort study

“…With MT, in addition to diagnostic parietal pleural biopsies, large volume therapeutic drainage of the pleural effusion and definitive intervention for fluid control such as administration of talc poudrage for pleurodesis or insertion of an indwelling pleural catheter (IPC) may also be performed concurrently. This allows for a ‘one stop’ approach to evaluation and management of symptomatic pleural effusions ( 5 , 6 ).…”