MALIGNANT PLEURAL EFFUSION

EFFICACY OF VIDEOASSISTED THORACOSCOPIC TALC PLEURODESIS IN THE SURGICAL MANAGEMENT OF PATIENTS

Abstract

Objectives: To assess the role of video assisted thoracoscopic talc pleurodesis
in the surgical management of malignant pleural effusions by comparing this procedure with
pleurodesis via talc slurry through an intercostals chest tube. Design: Prospective analysis
of fifty patients with malignant pleural effusion which were divided into two groups. Group
one included twenty patients while group two included thirty patients. Setting: Department of
Thoracic Surgery and the Department of Oncology, Combined Military Hospital, Rawalpindi.
Period: October 2008 till November 2010. Subjects: Fifty patients of malignant pleural effusion
were included in the study. They were divided into two groups. Group one included twenty
patients whereas group two included thirty patients. Interventions: Patients in group one
were subjected to videoassisted thoracoscopic talc pleurodesis. Patients in group two were
subjected to pleurodesis via talc slurry through an intercostal drainage tube. RESULTS: Fifty
patients were included in the study. The mean follow up time was 5.7 months for group one
and 5.5 months for group two. Out of the twenty patients in group one 95% had successful
pleurodesis (defined as satisfactory pleurodesis three months post procedure). Adverse effects
included fever in three patients (15%), empyema in one patient (5%) and malignant invasion
of the scar in one patient (5%). Out of the thirty patients in group two 70% had successful
pleurodesis. Adverse effects included fever in five patients (17%), empyema in one patient (3%),
and pulmonary infection in one patient (3%). No mortalities occurred during the procedures in
either of the group. Conclusions: Videoassisted thoracoscopic talc pleurodesis is a safe and
effective method of producing reliable pleurodesis in patients with malignant pleural effusion. It is
superior to pleurodesis via talc slurry through an intercostal drainage tube in terms of producing
a reliable and complete pleurodesis. It should be performed early in patients presenting with
malignant pleural effusions to avoid the risk of respiratory failure, this being directly linked to the
general and respiratory status of the patients at the time of the procedure.