Early and late morbidity and mortality and life expectancy following thoracoscopic talc insufflation for control of malignant pleural effusions: a review of 400 cases

Our plain-English summary of Early and late morbidity and mortality and life expectancy following thoracoscopic talc insufflation for control of malignant pleural effusions: a review of 400 cases, by N. Barbetakis, C. Asteriou, F. Papadopoulou, et al (Journal of Cardiothoracic Surgery, 2010).

The study

• Authors: N. Barbetakis, C. Asteriou, F. Papadopoulou, G. Samanidis, D. Paliouras, A. Kleontas, K. Lyriti, I. Katsikas, C. Tsilikas
• Journal: Journal of Cardiothoracic Surgery
• Published: 2010;5:27
• Cited by: 32 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural effusion is a common sequelae in patients with certain malignancies. It represents a terminal condition with short median survival (in terms of months) and the goal is palliation. Aim of our study is to analyze morbidity, mortality and life expectancy following videothoracoscopic talc poudrage.

Materials And Methods: From September 2004 to October 2009, 400 patients underwent video-assisted thoracic surgery (VATS) for malignant pleural effusion. The conditions of patients were assessed and graded before and after treatment concerning morbidity, mortality, success rate of pleurodesis and median survival.

Results: The median duration of follow up was 40 months (range 4-61 months). All patients demonstrated notable improvement in dyspnea. Intraoperative mortality was zero. The procedure was well tolerated and no significant adverse effects were observed. In hospital mortality was 2% and the pleurodesis success rate was 85%. A poor Karnofsky Performance Status and delay between diagnosis of pleural effusion and pleurodesis were statistically significant factors for in-hospital mortality. The best survival was seen in breast cancer, followed by ovarian cancer, lymphoma and pleural mesothelioma.

Conclusions: Video-assisted thoracoscopic talc poudrage is an effective and safe procedure that yields a high rate of successful pleurodesis and achieves long-term control with marked dyspnea decrease.

In plain English

This article reviewed 400 patients with malignant pleural effusion (cancer-caused fluid around the lung) treated in Thessaloniki, Greece, from September 2004 to October 2009. The design was retrospective. Each had video-assisted thoracoscopic surgery blowing 6 grams of sterile, asbestos-free talc powder into the chest to seal it (pleurodesis). The study did not examine asbestos exposure. Most had non-small cell lung cancer (166) or breast cancer (97); 10 had pleural mesothelioma. There were no operative deaths, and 66 patients had complications. Eight of 400 (2%) died in hospital and 15 of 400 (3.7%) within three months. In an unadjusted (univariate) analysis, poorer Karnofsky Performance Status and longer delay from diagnosis to pleurodesis were statistically significantly associated with in-hospital and three-month death. Pleurodesis succeeded in 340 of 400 (85%) at three months and 328 of 400 (82%) at six months. Average survival was longest in breast cancer (13.6 months). In pleural mesothelioma it was 9.6 months, with success in 8 of 10 patients at both time points. The authors concluded the method was safe and reliable. They noted that quality of life was not documented.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of a single hospital's case series of patients treated with thoracoscopic talc pleurodesis
• Who was studied: 400 patients (261 male, 139 female; median age 63.2, range 21-78) with symptomatic malignant pleural effusion treated at Theagenio Cancer Hospital, Thessaloniki, Greece, from September 2004 to October 2009. They included 166 with non-small cell lung cancer, 97 with breast cancer and 10 with pleural mesothelioma.
• Exposure: The treatment studied was thoracoscopic insufflation of 6 grams of sterile asbestos-free talc powder (talc poudrage) to achieve pleurodesis. Asbestos exposure was not studied.
• Main results:
  • There were no operative deaths and no major intraoperative complications in the 400 patients. The conversion rate to open surgery (thoracotomy) was 0%.
  • Postoperative complications occurred in 66 patients. The most common was prolonged air leak, in 36 patients (9%).
  • Eight of 400 patients (2%) died during hospitalization: 3 from pneumonia, 2 from pulmonary embolism, 2 from myocardial infarction and 1 from septic shock.
  • Within 3 months after pleurodesis, 15 of 400 patients (3.7%) died.
  • In univariate analysis, Karnofsky Performance Status and the delay between diagnosis of pleural effusion and pleurodesis were statistically significant factors (p less than 0.05) for in-hospital and 3-month mortality. Patients who died in hospital had a mean Karnofsky score of 60, compared with 74 in survivors, and a mean delay of 66 days, compared with 40 days. Age was also listed as an adverse factor but was not marked as significant.
  • Pleurodesis succeeded in 340 of 400 patients (85%) at 3 months and in 328 of 400 (82%) at 6 months. The results prose describes the 340 as having lasting pleural symphysis until death or last follow-up. The authors' failure rate of 15% was higher than in the other series they cited.
  • Average survival after pleurodesis was 13.6 months for breast cancer, 13.1 months for ovarian cancer, 10.2 months for lymphoma and 9.6 months for pleural mesothelioma. Among the 10 pleural mesothelioma patients, pleurodesis succeeded in 8 at both 3 and 6 months.
• The authors' conclusion: The authors concluded that videothoracoscopic talc poudrage was a safe and reliable method of pleurodesis for malignant recurrent pleural effusion, with a high long-term success rate. They also concluded that pleurodesis is likely to be more effective if done early after diagnosis and when the lung is free to re-expand.
• Limitations the authors state:
  • The retrospective design could have introduced bias, including patients who were unavailable for follow-up.
  • Quality of life was not documented in the months after the procedure.
  • Pleural fluid characteristics linked in other studies to survival, such as pH and glucose, were not examined.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Life Expectancy, Talc, Pleural Effusion, Median Overall Survival, Thoracic Surgery, Video-Assisted Thoracoscopic Surgery (VATS), Pleurodesis, Dyspnea.

Related studies

• Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series — D.C. Mares, P.N. Mathur (1998)
• Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients — K. Arapis, R. Caliandro, et al. (2006)
• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)
• Survival in patients with malignant pleural effusion undergoing talc pleurodesis — M. Hassan, R.M. Mercer, et al. (2019)
• Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis — M. Yeung, E.W. Loh, et al. (2020)
• Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis — T. Laisaar, V. Palmiste, et al. (2006)

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