THORACOSCOPIC TALC POUDRAGE PLEURODESIS FOR CHRONIC RECURRENT PLEURAL EFFUSIONS

Objective: To assess the effectiveness of thoracoscopic talc poudrage for the treatment of chronic pleural effusions. Design: Prospective evaluation. Setting: Kaiser-Permanente Hospital. Patients: Forty-seven consecutive patients with recalcitrant pleural effusions, referred for thoracoscopy. Intervention: Patients received general or local anesthesia; 42 had a 7-mm rigid thoracoscopic examination followed by insufflation of 5 mL of talc. Patients then had chest-tube drainage. Measurements: We recorded clinical characteristics, final diagnosis, procedure-related pain and morbidity, days of hospitalization, patient-reported degree of symptom relief, and chest roentgenographic results at 1, 3, and 12 months. All patients were followed for 16 months or until death. Main Results: Of 39 evaluable patients, all reported prolonged relief of effusion-related dyspnea. Radiographic results confirmed the elimination of pleural effusions in 34 patients (87%), including all 11 with benign conditions and 23 of 28 (82%) with malignancies. Treatment failed in three patients because of entrapped lung and in two patients with mesotheliomas whose effusions recurred more than a year after treatment. No procedure-related mortality or morbidity was found. Ambulatory patients required hospitalization for a mean of 3.9 days (range, 2 to 11 days). Mild pain was reported by some patients. The mean duration of chest-tube drainage was 2.7 days (range, 1 to 9 days). Patients with malignant disease lived an average of 12.4 months (range, 1 to 61 months) after the procedure. Conclusions: Thoracoscopic talc poudrage is an effective pleural sclerosing technique and is relatively painless.