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.


METHODS
Prospective evaluation.


METHODS
Kaiser-Permanente Hospital.


METHODS
Forty-seven consecutive patients with recalcitrant pleural effusions, referred for thoracoscopy.


METHODS
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.


METHODS
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.


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.
Department of Internal Medicine, Southern California Permanente Medical Group, Harbor City 90710.
Y
Y
Aelony
R
R
King
C
C
Boutin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000628:therapy*; D012008:Recurrence; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy / Q000379:methods*; D015996:Survival Rate; D013627:Talc / Q000627:therapeutic use*; D013906:Thoracoscopy
D012597:Sclerosing Solutions; D013627:Talc