Early and late morbidity and mortality and life expectancy following thoracoscopic talc insufflation for control of malignant pleural effusions: a review of 400 cases

Abstract

BackgroundMalignant pleural effusion is a common sequelae in patients with certain malignancies. It represents a terminal condition with short median survival (in terms of months) and the goal is palliation. Aim of our study is to analyze morbidity, mortality and life expectancy following videothoracoscopic talc poudrage.Materials and methodsFrom September 2004 to October 2009, 400 patients underwent video-assisted thoracic surgery (VATS) for malignant pleural effusion. The conditions of patients were assessed and graded before and after treatment concerning morbidity, mortality, success rate of pleurodesis and median survival.ResultsThe median duration of follow up was 40 months (range 4-61 months). All patients demonstrated notable improvement in dyspnea. Intraoperative mortality was zero. The procedure was well tolerated and no significant adverse effects were observed. In hospital mortality was 2% and the pleurodesis success rate was 85%. A poor Karnofsky Performance Status and delay between diagnosis of pleural effusion and pleurodesis were statistically significant factors for in-hospital mortality. The best survival was seen in breast cancer, followed by ovarian cancer, lymphoma and pleural mesothelioma.ConclusionsVideo-assisted thoracoscopic talc poudrage is an effective and safe procedure that yields a high rate of successful pleurodesis and achieves long-term control with marked dyspnea decrease.

Review of malignant pleural mesothelioma survival after talc pleurodesis or surgery

“…Dyspnea, caused by the accumulation of fluids in the pleural space, is an important symptom among MPM patients which negatively impacts quality of life (5). Talc pleurodesis is shown to be effective, safe and successful in the prevention of fluid accumulation achieving a long-term control with a marked improvement of dyspnea (4). The studies reporting on 1-year survival are scarce for talc and prevent any firm conclusion; such studies however suggest that surgery is still the nest option, and that EPP patients fare better than P/D patients.…”

“…Talc pleurodesis has been used in the treatment of malignant pleural effusion (MPE), a common complication of advanced malignancies especially breast and lung cancer (4). Talc is distributed over the entire pleural surface by administering it as a dry powder, usually during thoracoscopy, or as slurry via a chest tube (5).…”

Infections Associated With Tunnelled Indwelling Pleural Catheters in Patients Undergoing Chemotherapy

“…[1][2][3][4][5][6][7] Given this limited survival, treatment should aim at relieving symptoms and improving function while minimizing the need for hospitalization. Patients undergoing chemotherapy while the TIPC is in place do not seem to have an increased risk of infection, and therefore chemotherapy should not necessarily be viewed as a contraindication to TIPC insertion.…”

The Use of Indwelling Tunneled Pleural Catheters for Recurrent Pleural Effusions in Patients With Hematologic Malignancies

“…1,2 Advances in pleural palliation have led to the rather widespread adoption of the indwelling tunneled pleural catheter (IPC) as a tool for managing symptomatic, recurrent MPEs. Th is includes current British Th oracic Society guidelines, which off er a grade B recommendation for IPC placement as "eff ective in controlling recurrent and symptomatic malignant eff usions in select patients."…”