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Original Research: INTERVENTIONAL PULMONOLOGY |

Is Full Postpleurodesis Lung Expansion a Determinant of a Successful Outcome After Talc Pleurodesis?

Ricardo Mingarini Terra, MD; Jader Joel Machado Junqueira, MD; Lisete Ribeiro Teixeira, MD, FCCP; Francisco Suso Vargas, MD; Paulo Manuel Pêgo-Fernandes, MD; Fábio Biscegli Jatene, MD
Author and Funding Information

From the Division of Thoracic Surgery (Drs. Terra, Junqueira, Pêgo-Fernandes, and Jatene), and Pulmonary Division (Drs. Texeira and Vargas), Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.

Ricardo Mingarini Terra, MD, Al Fernao Cardim, 161, Apartment 61–Jardim Paulista, São Paulo, SP Brazil CEP 01403-020; e-mail: rmterra@uol.com.br


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(2):361-368. doi:10.1378/chest.08-2448
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Study objectives:  To analyze and compare radiologic lung expansion after talc pleurodesis performed either by videothoracoscopy or chest tube and correlate it with clinical outcome. Secondary end points evaluated were as follows: clinical efficacy; quality of life; safety; and survival.

Methods:  Prospective randomized study that included 60 patients (45 women, 15 men; mean age, 55.2 years) with recurrent malignant pleural effusion between January 2005 and January 2008. They were randomized into the following two groups: video-assisted thoracic surgery (VATS) talc poudrage; and talc slurry (TS) administered through a chest tube. Lung expansion was evaluated through chest CT scans obtained 0, 1, 3 and 6 months after pleurodesis. Complications, drainage time, hospital stay, and quality of life (Medical Outcomes Study 36-item short form and World Health Organization quality-of-life questionnaires) were also analyzed.

Results:  There were no significant differences in preprocedure clinical and pathologic variables between groups. The immediate total (ie, > 90%) lung expansion was observed in 27 patients (45%) and was more frequent in the VATS group (60% vs 30%, respectively; p = 0.027). During follow-up, 71% of the patients showed unaltered or improved lung expansion and 9 patients (15%) needed new pleural procedures (VATS group, 5 recurrences; TS group, 4 recurrences; p = 0.999). No differences were found between groups regarding quality of life, complications, drainage time, hospital stay, and survival. Immediate lung expansion did not correlate with radiologic recurrence, clinical recurrence, or complications (p = 0.60, 0.15, and 0.20, respectively).

Conclusion:  Immediate partial lung expansion was a frequent finding and was more frequent after TS. Nonetheless, no correlation between immediate lung expansion and clinical outcome was found in this study.

Trial registration:  ClinicalTrials.gov Identifier: NTC00789087

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