PURPOSE:Talc pleurodesis is a therapeutic option for recurrent malignant pleural effusion; however, the best intrapleural delivery method is still controversial. The purpose of this study was To compare two intrapleural talc delivery methods (videothoracoscopy or talc slurry) considering efficacy, safety, quality-of-life and post-procedure radiological results.
METHODS:Prospective randomized study that included 60 patients (45 Female, 15 Male and mean age: 55, 2 years) with recurrent malignant pleural effusion. They were enrolled into two groups: videothoracoscopic talc insuflation (VATS) and talc slurry through a small-bore chest tube (TS). The efficacy was evaluated through clinical (failure = new pleural procedures required) and radiological (failure = fluid reaccumulation on CT scan according to two blinded observers) parameters. Complications, drainage time and hospital stay were recorded. SF-36 and World Health Organization questionnaires were applied before and 1 month after the procedure for quality-of-life analysis. Chi-square, Fisher test, Kruskall-Wallis test, double factor Variance and log-rank were used for statistical analysis, p<0.05 was considered significant.
RESULTS:The median survival was 9 months for VATS patients and 6 months for TS (p=0.793). Clinical recurrence occurred in 9 patients (VATS (5), TS (4), p=0.999), radiological recurrence occurred in 17 patients (VATS (7), TS (10), p=0.390). Most clinical (77.7%) and radiological (52.9%) recurrences occurred within the first month. No statistical difference was found between groups regarding complications, drainage time, hospital stay and quality of life. Post-procedure CT scan showed lung expansion >90% in 60% of VATS patients and in 30% of TS patients (p<0.05), post-procedure lung expansion showed no correlation with clinical outcome.
CONCLUSION:The intrapleural delivery method showed no influence on pleurodesis efficacy, safety and quality-of-life. VATS allowed a better postoperative lung expansion; however, lung expansion had no correlation with final outcome.
CLINICAL IMPLICATIONS:Both methods had similar results, even though VATS had offered a better radiologic postoperative outcome. This conclusion suggests that less invasive procedures might be more appropriate for those patients despite the worse immediate radiologic appearance.
DISCLOSURE:Ricardo Terra, None.