Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients

Our plain-English summary of Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients, by K. Arapis, R. Caliandro, J.B. Stern, et al (Surgical Endoscopy, 2006).

The study

• Authors: K. Arapis, R. Caliandro, J.B. Stern, P. Girard, D. Debrosse, D. Gossot
• Journal: Surgical Endoscopy
• Published: 2006;20(6):919-23
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The aim of this study was to analyze the results of pleurodesis for malignant pleural effusion performed by surgeons.

Patients And Methods: A series of 273 patients with malignant pleural effusion underwent thoracoscopy with the aim of performing a palliative pleurodesis. There were 94 males (34.4%) and 175 females (64.1%), ranging in age from 15 to 94 years (mean age: 60.6 years). The effusion was on the right side in 136 patients (49.8%), on the left side in 110 (40.3%), and bilateral in 27 (9.9%). Thoracoscopy was performed under general anaesthesia in all patients. Pleural biopsy was performed in two thirds of the patients (70.7%). Pleurodesis was produced by instillation of 5g of sterile asbestos-free talc; the chest tube was left in place a minimum of 3 days. It was removed when fluid drainage was less than 200 ml/24 h. Patients were usually discharged the day after chest tube removal.

Results: There was no intraoperative mortality. Two patients (0.7%) had intraoperative complications; 17 (6.2%) underwent a bilateral pleurodesis, and 10 (3.7%) had a pericardiopleural window. In 32 patients (11.7%) no pleurodesis was done, either because the lung did not properly re-expand (5.2%), or because of suspected infection, e.g., false membranes (1.9%), or because of multiple adhesions (4.6%). Finally, only 241 patients (88.3%) had a talc poudrage at the time of thoracoscopy. Duration of postoperative pleural drainage ranged between 1 and 11 days (mean: 3.64 days). The postoperative hospital stay ranged from 2 to 21 days (mean: 7.1 days). Pleural empyema occurred in 4 patients (1.5%) and was lethal in one patient. The mean follow-up period was 8.39 (7.2 months, and 172 patients had regular follow up. In this group, there were 24 recurrences (14%), 12 of which were treated by repeat pleurodesis. The results were very good in 133 patients (77.3%), acceptable in 35 patients (20.3%), and there was a failure in 4 patients (2.4%).

Conclusions: Results of surgical thoracoscopy for malignant pleural effusion are good, with low morbidity. However, in debilitated patients, bedside talc slurry may be preferable.

In plain English

This was a report on a consecutive series of 273 patients with malignant pleural effusion (fluid around the lung caused by cancer), treated in a Paris thoracic department from January 2000 to October 2004. Asbestos appeared only in the description of the talc used as sterile asbestos-free talc. Breast cancer was the most common original cancer (115 patients), and 8 patients had mesothelioma. Under general anaesthesia, surgeons examined the chest with a camera and sprayed in 5 g of talc. They did not do so when the lung did not re-expand properly, infection was suspected, or there were multiple adhesions. No patient died during surgery, and 241 patients (88.3%) received talc. Complications after surgery occurred in 43 patients (15.7%), and one death after surgery was related to streptococcal sepsis. Of 172 patients seen at follow-up, 133 (77.3%) reported markedly improved breathlessness and 4 (2.4%) reported worsening. The other 35 (20.3%) are described as slightly improved in the text but as unchanged in a table. Another 71 patients were lost to follow-up. Median survival after pleurodesis was 7 months. The authors concluded that results were good with low morbidity, but that bedside talc slurry may be preferable for debilitated patients.

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: Consecutive case series reporting the results of thoracoscopic talc pleurodesis performed by surgeons
• Who was studied: 273 patients with malignant pleural effusion (94 males, 175 females, aged 15 to 94 years, mean 60.6 years), treated at the Thoracic Department, Institut Mutualiste Montsouris, Paris, from January 2000 to October 2004
• Exposure: Not an asbestos exposure study. The treatment studied was thoracoscopy under general anaesthesia, with instillation of 5 g of sterile asbestos-free talc. Talc was withheld if the lung did not re-expand properly, infection was suspected, or there were multiple adhesions
• Main results:
  • Primary (original) cancers: breast carcinoma was the most common, in 115 patients (42.1%). Mesothelioma accounted for 8 of 273 patients (2.9%)
  • No patient died during surgery, and 2 of 273 patients (0.7%) had complications during the operation
  • 32 patients (11.7%) did not receive pleurodesis. The reasons were that the lung did not re-expand properly (5.2%), infection was suspected, for example false membranes (1.9%), or there were multiple adhesions (4.6%). In the end, 241 patients (88.3%) had talc poudrage
  • The morbidity rate after thoracoscopy was 16% (43 patients, 15.7%, in Table 2). This included fever in 5.3% of patients and empyema in 4 patients (1.5%)
  • One death after surgery was related to streptococcal sepsis, in a patient with low-grade lymphoma and neutropenia
  • The postoperative hospital stay ranged from 2 to 21 days (mean 7.1 days)
  • Among the 172 patients seen at follow-up, 133 (77.3%) said their breathlessness was markedly improved and 4 (2.4%) said their breathing had worsened. The remaining 35 (20.3%) are described in the text as reporting only slight improvement but are listed in Table 4 as 'No change'
  • At the first follow-up visit (1 month), chest films showed no pleural effusion in 122 patients (71%), a small residual effusion in 39 (23%), and a recurrence in 11 (6%)
  • Among patients seen at follow-up, 35 (20.3%) died during the first 3 months. Median survival after pleurodesis was 7 months, and mean survival was 9.2 months
• The authors' conclusion: The authors concluded that results of surgical thoracoscopy for malignant pleural effusion are good, with low morbidity, but that bedside talc slurry may be preferable in debilitated patients
• Limitations the authors state:
  • The authors reported that 71 patients were lost to follow-up because the poor condition of some patients made it impossible for them to attend. They stated that the 172 patients who were followed were comparable to the original group in gender and primary cancer

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: Palliative Care, Pleural Effusion, Pleurodesis, Thoracoscopy, Bilateral, Pleural Biopsy, Asbestos-Free Talc, Talc.

Related studies

• Palliative treatment of malignant pleural effusions — D. Horn, D. Dequanter, et al. (2010)
• MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial — C. Matthews, C. Freeman, et al. (2019)
• Video-assisted management of malignant pleural effusion in breast carcinoma — R. Gasparri, F. Leo, et al. (2006)
• Prognostic factors for survival after surgical palliation of malignant pleural effusion — J.E. Pilling, M.E. Dusmet, et al. (2010)
• Protocol of the Australasian Malignant Pleural Effusion-2 (AMPLE-2) trial: a multicentre randomised study of aggressive versus symptom-guided drainage via indwelling pleural catheters — M. Azzopardi, R. Thomas, et al. (2016)
• Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis — M. Yeung, E.W. Loh, et al. (2020)

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