PURPOSE: Aim of this study was to determine the safety and long and medium term efficacy of pleurodesis by video-assisted-thoracoscopic talc poudrage, and the patient grade of benefit.
METHODS: This prospective study included 78 evaluable cases on 108 consecutive cancer patients suffering of malignant pleural effusion from March 2006 to March 2008.We excluded 20 cases with non expandable lung after thoracentesis, 7 for poor performance status and the remainders 3 had a slurry talcage by chest drainage. The most frequent primitive tumor was pulmonary (n=43) followed by breast cancer recurrence (n=20) and malignant pleural mesothelioma (MPM) (n=5). Nineteen patients (24,3%) had previously treated for recurrent effusion. The disease diagnosis interval and the talcage has been average of 5.2 weeks (range 1–24 weeks). In 9 cases, for the clinical conditions, we performed the VATS by mask anesthesia.Only one access was employed in 65 VATS procedures (83.3 %), 2 ones in the remaining 13 cases (16.6 %). Six pericardial windows were performed for pericardial tamponade. To chemical pleurodesis we used steril talc in 8 g dosage. All the patients underwent pre and post-operatively chest X-ray, pulmonary functional tests, blood gas analyses, and requested the grade of benefit.
RESULTS: The effusion was evacuated (media 1500 cc) with a range between 200–5.000 cc in all 78 patients. The mean hospital stay was 4.5 days. There were no-surgical neither allergic VATS related complications. Sixty-nine patients (88,4%) have grave dyspnoea before the talcage; after, 63 patients (91.3%) referred important improving of symptoms but for 6 ones. In the 9 patients with moderate pre-operative dyspnoea, this disappeared in 4 cases, it became light in 4 and it was reported worsening in one. The patient's percentage of free pleural effusion was after 1 month 93.5 %, after 6 months it was 90.1 % and after 1 year it was 76,9%.
CONCLUSION: Video-thoracoscopic talc poudrage is a safe and efficacy procedure.
CLINICAL IMPLICATIONS: VATS talcage improves in most of patients with malignant pleural effusion their respiratory function and quality of life.
DISCLOSURE: Gabriella Giudice, No Financial Disclosure Information; No Product/Research Disclosure Information