Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax

Abstract

The aim of the present study was to evaluate the long-term outcome of patients with primary spontaneous pneumothorax treated with talc pleurodesis.A follow-up study was undertaken in all patients with primary spontaneous pneumothorax who underwent talc pleurodesis for prolonged air leak or recurrence using thoracoscopy.In total, 112 patients underwent pleurodesis and follow-up data was obtained in 63 (56%) patients: 45 patients were available for clinical follow-up, 14 for telephone follow-up and four were dead. The causes of death were unrelated to the pleurodesis. There were no episodes of acute respiratory failure following pleurodesis. A total of 56 (95%) out of the cohort of 59 patients had a successful pleurodesis. Surgical pleurectomy was required in three (5%) patients for persistent air leak. Median duration of follow-up after talc pleurodesis was 118 months. Long-term success was observed in 53 (95%) out of 56 patients. Recurrent pneumothorax was observed in three (5%) out of 56 patients. Patients with successful talc pleurodesis had a median forced vital capacity (FVC) of 102% and median total lung capacity of 99% at follow-up. Comparing smokers and nonsmokers, the forced expiratory volume in one second (FEV1) was significantly lower in smokers and there was a tendency for the FEV1/FVC ratio to be lower in smokers.Talc pleurodesis in patients with primary spontaneous pneumothorax via thoracoscopy is an effective procedure associated with normal lung function in patients who do not smoke.

Short-term safety of thoracoscopic talc pleurodesis for recurrent primary spontaneous pneumothorax: a prospective European multicentre study

“…Talc pleurodesis has been shown to be efficacious and safe with a success rate of 95% in PSP in large series [6][7][8][9][25][26][27].…”

“…Moreover, a recent study from North America using a higher dosage of talc (6 g) of unknown calibration raised concern about respiratory deterioration after thoracoscopic talc poudrage, even if the used talc was the only one approved by the US Food and Drug Administration [13]. Recent studies using graded talc with large particle size failed to observe ARDS cases [3,7,28]. In addition, in humans, systemic side-effects of talc appear to be related to overdoses of talc or uncalibrated talc with small particles [17].…”

“…In a prospective cohort study, JANSSEN et al [5] recently demonstrated that thoracoscopic large-particle talc poudrage is safe in the treatment of malignant pleural effusions. Apart from treating malignant pleural effusions, graded talc has been extensively and safely used in Europe for .70 yrs for pleurodesis in recurrent spontaneous pneumothorax and has been shown to be well tolerated without long-term sequellae [6][7][8][9].…”

Who's (still) afraid of talc?

“…Size-calibrated talc does not cause ARDS or death. In the long term, talc does not cause cancer, pulmonary fibrosis, impaired thoracic surgical re-interventions or decreased pulmonary function, as shown by GYÖ RIK et al [31] in the current issue of the ERJ. This makes talc suitable for pleurodesis in benign conditions, such as spontaneous pneumothorax.…”

Taurolidine: A New Alternative Agent for the Management of the Postoperative Air Leak

“…However, this same anti-adhesion effect is beneficial in the management of postoperative air leak, which needs not permanent pleural symphysis but immediate air leak cessation, because pleural symphysis can decrease pulmonary function. 23,24) TRD is known as a safe drug without severe toxicity. Its most common reported side effect is local reaction, and systemic clinically relevant adverse events were minimal.…”