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Poster Presentations: Tuesday, November 2, 2010 |

Water Management: 12 Years of Dry Talc Powder Pleurodesis by Thoracoscopy in a Wet Environment FREE TO VIEW

Marinus Schrijver, MD; Pauline C. Dekker, MD; Marina F. Gaans-Ort, NP; Liesbeth A. Peters, MD; Annelike Vrieze, MD
Author and Funding Information

Gemini Ziekenhuis, Den Helder, Netherlands



Chest. 2010;138(4_MeetingAbstracts):346A. doi:10.1378/chest.9786
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Abstract

PURPOSE: From 1987, we approache Malignant Pleural Effusion with Diagnostic Pleurocenthesis, folowed by Thoracoscopy (local anaesthesia), with dry Talc powder(8-10 grams)Pleurodesis with good results. Dutch (NVALT) guideline (2003), promotes small calibre chest tubes, scheduled evacuation of Pleura fluid, 1-1,5 litres at a time. Talc-slurry Pleurodesis if complete expansion of the lung. Talc dosage only 5 grams. We performed a retrospective study to evaluate our approach.

METHODS: All Thoracoscopy procedures for Malignant Pleura effusions between 1995 and 2007 in our institute.

RESULTS: 338 Procedures. (Mean 26 a year). 175 for Malignant Pleural Effusions. (14,5 a year). 115 males, 60 females.Mean Hospital Stay 7,7 days. (2-87 days). Pleural Fluid amount: 0,8-6,45 L.Mean follow-up: 233,5 days, (3-3174 days).Mean age: 67,6 year (38-92 year).Causes: Metastatic Cancer: 56,6% (Mamma, Ovarian, Lung, Colon, Renal, Thyroid, Tongue, Vulva, Pancreas). Malignant Mesothelioma: 39%. Malignant Lymphoma: 1,7% Primary Pleural Osteosarcoma: 0,6%.Radiological results defined as "Good" (Complete expansion of the lung): 103 patients (60,6%), "Intermediate" (Incomplete expansion): 54 patients (31,8%), or "Bad" (Trapped Lung): 13 patients (7,6%).Clinical results considered as" Good" (No further Pleural procedures): 150 patients (89,8%), "Intermediate" (One or more Pleurocenthesis): 11 patients (6,6%), or "Failure" (Re- Thoracoscopy, Clagett Procedures, permanent tunnelled subcutaneous drains): 6 patients (3,6%). 3 came from the group with Trapped Lung. In 77% of all cases with Trapped Lungs, good clinical results achieved. Complications: Re-expansion oedema: 1x. (Clinical insignificant). Empyema: 4x. Fever 14x. Sudden Death: 1x (Pulmonary Embolism). Persistent Fluid leakage: 10x, treated with wet Pleurodesis (Talc, Vitamin C). Persistent Air leakage: 8x. (2 cases permanent tunnelled drains).Results with only follow-up longer than 21 days: 137 Thoracoscopy Procedures. Males: 88, females: 49.Radiological Results: "Good": 80 patients (59,3%), "Intermediate": 44 patients (32,6%), "Bad": 11 patients (8,2%). Clinical outcomes: "Good": 119 patients (88,1%), "Intermediate": 11 patients (8,1%), "Bad": 5 patients (3,7%).

CONCLUSION: Thoracoscopy is a safe, highly diagnostic procedure, with superior palliative results. Good palliation even in Trapped Lungs.

CLINICAL IMPLICATIONS: Medical Thoracoscopy still is a very important tool for every Pulmonologists, dealing with (Malignant) Pleural Effusions.

DISCLOSURE: Marinus Schrijver, No Financial Disclosure Information; No Product/Research Disclosure Information

12:45 PM - 2:00 PM


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