PURPOSE: Current treatment options for patients with recurrent and symptomatic malignant pleural effusion include either talc pleurodesis with hospital stays averaging 5 days or placement of an indwelling tunneled catheter with average catheter time of 56 days and a pleurodesis success of less than 50%. We investigated whether rapid pleurodesis could be achieved with the combined use of these two modalities, with a hospital stay of about 24 hours.
METHODS: Seven patients with recurrent, symptomatic malignant pleural effusions and evidence of lung re-expansion after thoracentesis underwent medical thoracoscopy with talc poudrage (5g) and an indwelling tunneled catheter was inserted under direct visualization at the time of thoracoscopy. A 24-F chest tube was placed as well. The patients were admitted to the hospital overnight on low wall suction, a chest X-ray performed the following morning, and the chest tube was removed. The indwelling tunneled catheter was used to drain the pleural space with decreasing frequency until drainage was less than 150cc per day.
RESULTS: Rapid pleurodesis was performed in 7 patients. The chest tube was successfully removed from all patients within an average of 24.4 hours. 3 patients left the hospital the same day, while 4 remained hospitalized for an average of 6.9 days for reasons unrelated to the procedure. The indwelling catheter was removed from 6 patients on average of 6.7 days. 1 patient died with the catheter in place. Pleurodesis was achieved in all 7 patients as confirmed by lack of drainage, chest imaging, and symptomatic relief. At 30-day follow-up, 6 patients reported significant improvement in their quality of life and level of function outside the hospital. 2 patients died from their underlying disease, one at day 11 and one at day 32-post procedure.
CONCLUSION: Rapid pleurodesis for malignant pleural effusion is safe and effective and may reduce hospital length of stay.
CLINICAL IMPLICATIONS: Rapid pleurodesis is a safe and effective alternative for patients with malignant pleural effusion.
DISCLOSURE: Yaron Goldman, None.