Thoracoscopy talc poudrage : a 15-year experience.
OBJECTIVE
To review our experience with thoracoscopy and talc poudrage during the previous 15 years with regards to efficacy, side effects, morbidity, and mortality.


METHODS
Six hundred fourteen consecutive patients (58.6% female; mean age, 54.5 years) underwent thoracoscopy with talc poudrage from August 1983 to May 1999. Of these, 457 patients had malignant pleural effusions, 108 patients had benign pleural effusions, and 49 patients had spontaneous pneumothorax.


RESULTS
Sixty-four patients were excluded from evaluation for efficacy: 30 patients (4.9%) because the lung did not expand at the time of the procedure and 34 patients (5.5%) because they died within 30 days of the thoracoscopy. All exclusions were in the malignant group. The overall success rate of the 393 patients with malignant pleural effusions was 93.4%, while the overall success for the 108 patients with benign effusions was 97%, although 7 patients (7%) with benign effusions required a second thoracoscopy. The success rate with pneumothorax was 100%. Major morbidity included empyema in 4%, reexpansion pulmonary edema in 2.2%, and respiratory failure 1.3%.


CONCLUSIONS
Thoracoscopy with talc poudrage is effective in producing a pleurodesis in malignant and benign pleural effusion and in spontaneous pneumothorax. However, it should be noted that the insufflation of talc has a systemic distribution associated with a low rate of morbidity and perhaps does induce ARDS, which is sometimes fatal in a small percentage of patients. Because of these side effects, the search for a better agent should be continued.
Division of Thoracic Surgery, University of San Paulo, Medical School, San Paulo, Brazil. jribas@usp.br
J R
JR
de Campos
F S
FS
Vargas
E
E
de Campos Werebe
P
P
Cardoso
L R
LR
Teixeira
F B
FB
Jatene
R W
RW
Light
D005260:Female; D006801:Humans; D007327:Insufflation; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010996:Pleural Effusion / Q000628:therapy*; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D018700:Pleurodesis / Q000009:adverse effects / Q000706:statistics & numerical data; D011030:Pneumothorax / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000209:etiology; D013627:Talc / Q000008:administration & dosage* / Q000009:adverse effects; D013906:Thoracoscopy / Q000706:statistics & numerical data; D016896:Treatment Outcome
D013627:Talc