Instillation of talc slurry to produce pleurodesis is the standard treatment of symptomatic malignant pleural effusions. However, pleurodesis is associated with numerous complications and has variable success rates. At our institution the pleurodesis is performed via small bore chest tubes. The objective of this study was to review our local experience with pleurodesis, in order to determine patient outcomes and to identify areas for improvement.
We performed a two-year (2001 & 2002) retrospective chart review at a tertiary care centre. All patients in whom a chest medicine consultation was obtained for the purpose of pleurodesis of a malignant pleural effusion, were included. Patients who required thoracoscopy or sclerosant other than talc slurry were excluded. The outcome was defined as success (complete or partial resolution of the pleural effusion) or failure (non-resolution of the pleural effusion). An attempt was also made to identify predictors of success or failure of this procedure.
Twenty-eight patients with thirty-one malignant pleural effusions were identified. In twelve effusions (39%) the procedure could not be performed because of blockage of the chest tube. In nineteen effusions where talc slurry was instilled, eleven (58%) had a successful outcome. Blockage of the chest tube appeared to be the most common predictor of a poor outcome for all patients referred for pleurodesis.CONCLUSIONS: The success rate at our institution is lower than that reported in the literature (62 – 85%). A successful outcome has been associated with factors including patient selection (lower tumor burden, pleural fluid pH > 7.15), chest tube size, sclerosant used and duration to sclerosis. Based on this review, we have introduced changes to the pleurodesis procedure at our institution, and have initiated a prospective study to evaluate impact of these changes in practice, for this commonly performed procedure.
Pleurodesis for malignant pleural effusions is feasible with a small-bore chest tube. However the success depends on appropriate patient selection and meticulous follow up of an established protocol.
K. Kemp, None.