Efficacy of medical thoracoscopic talc pleurodesis in malignant pleural effusion caused by different types of tumors and different pathological classifications of lung cancer

Abstract

The aim of this study was to assess the efficacy and complications and compare the efficacy of medical thoracoscopic talc pleurodesis among patients with different types of tumors and different pathological classifications of lung cancer as well as to evaluate the role of postoperative negative pressure chest tube drainage. A total of 1061 patients with malignant pleural effusion who underwent thoracoscopic pleurodesis were analyzed retrospectively. The complications, postoperative drainage time, and efficacy of pleurodesis among patients with different types of tumors and different pathological classifications of lung cancer were assessed. The overall response rate (ORR) was 88.03%. Major complications included chest pain (68%) and fever (47%). The postoperative drainage time was 4.74 ± 1.56 days. Postoperative negative pressure chest tube drainage significantly shortened the drainage time (negative vs. non-negative: 4.56 ± 1.49 days vs. 4.81 ± 1.59 days, P = 0.037). Pleurodesis was less effective in treating effusion caused by lung cancer (72.3%) and mesothelioma (68.2%) than that caused by breast cancer (84.4%) and other tumors (87.8%) (P = 0.009). The efficacy in the treatment of effusion caused by adenocarcinoma (66.7%) was slightly less than that caused by other types of lung cancer (P = 0.311). In conclusion, medical thoracoscopic talc pleurodesis is a palliative and effective treatment for malignant pleural effusion. In addition, postoperative simple negative pressure chest tube drainage significantly shortens the drainage time. However, thoracoscopic pleurodesis is less effective for the treatment of effusion caused by lung cancer and pleural mesothelioma compared with that caused by other types of cancers.

Keywords: Malignant pleural effusion; cancer; medical thoracoscopy; pleurodesis.

Figure 1

Representative thoracoscopic images of the pleura following thoracoscopic talc powder spraying. Panels A (pleural mesothelioma) and B (pleural metastasis of lung adenocarcinoma) show the thoracoscopic images of patients. Panels C (pleural mesothelioma) and D (pleural metastasis of lung adenocarcinoma) show the images after talcum powder spraying, respectively. Panels E (pleural mesothelioma) and F (pleural metastasis of lung adenocarcinoma) show pleural effusions in pathology samples (HE staining, 200 ×).