For patients with recurrent malignant pleural effusions, talc pleurodesis has been shown to eliminate the need for repeated thoracentesis. While patients often experience symptomatic relief of dyspnea, little data exists to objectively quantify the impact of pleurodesis upon pulmonary function. At our institution, medical video-assisted thoracoscopic surgery (VATS) with talc pleurodesis is the preferred procedure for patients with recurrent malignant pleural effusions. Our study measures the effect of medical VATS with talc pleurodesis on pulmonary function tests (PFTs).
A retrospective analysis was performed on 163 medical VATS with talc pleurodesis cases performed at our institution between 1995 and 2004. Patients underwent poudrage with 4-8 grams of sterile talc. Chart review was done to obtain demographic and historical data. All pulmonary function data was obtained from our institution. We included patients who had PFTs performed 4-12 weeks after the operation. The majority did not have baseline PFTs, so analysis was made using post-procedure lung function compared to predicted lung function.
Of the 163 medical VATS cases, 38 patients had post-operative PFTs within 12 weeks. Of these patients, 27 (71%) were female; 11 (29%) were male. The primary malignancies were breast (n=20, 52.6%), lung (n=6, 15.7%), and ovarian (n=2, 5.2%). Of the 38 patients who underwent PFTs within 4-12 weeks, the post-procedure mean FVC was 54% predicted, FEV1 was 55% predicted, FEV1/FVC ratio was 80% predicted, TLC was 67% predicted, and DLCO was 52% predicted.
Successful pleurodesis was achieved in 94.6% of patients; however, patients who underwent VATS with talc pleurodesis demonstrated a loss of lung capacities. There was a moderately severe decrease in FVC and FEV1 and moderate decrease in TLC without alteration in the normal FEV1/FVC ratio, consistent with restrictive pulmonary disease. There was also a moderate decrease in diffusing capacity.
For patients with severe dyspnea due to recurrent malignant pleural effusions, medical VATS with talc pleurodesis can provide significant symptomatic relief. However, this benefit may be accompanied by a decrease in TLC and DLCO.
S.R. Goldyn, None.