Management of recurrent malignant pleural effusion with chemical pleurodesis.
OBJECTIVE
Malignant pleural effusion is a common complication of primary and metastatic pleural malignancies. It is usually managed by drainage and pleurodesis, but there is no consensus as to the best method of pleurodesis. We compared the effectiveness, side effects, and cost of different chemical pleurodesis agents used in patients with malignant pleural effusion.


METHODS
Between January 1990 and December 2001, 108 patients with malignant pleural effusion underwent chemical pleurodesis in our department. Thoracoscopy was performed in 64 patients (59%), a minithoracotomy in 18 (17%), tube thoracostomy in 11 (10%), and a small-bore catheter was inserted in 15 (14%). Talc was used in 68 (63%) patients, tetracycline in 26 (24%), and bleomycin in 14 (13%). Talc was instilled by insufflation during surgery after drainage, whereas tetracycline and bleomycin were instilled via tube or catheter for pleural analgesia.


RESULTS
Talc resulted in significantly earlier tube and catheter removal, after an average 4.1 days versus 5.1 days after tetracyline, and 6.3 days after bleomycin (P = 0.026, P = 0.001, respectively). A significantly lower reaccumulation ratio in 90 days was achieved by the talc group, with nine (13.2%) patients, representing an 86.8% success rate, than in the tetracyline and bleomycin groups, with seven (26.7%) and five (35.7%) patients, respectively, representing 73.8% and 64.3% success rates (P = 0.04).


CONCLUSIONS
Talc resulted in the earliest expansion, minimal drainage, and the earliest tube and catheter removal.
Kilic
Dalokay
D
Department of Thoracic Surgery, Başkent University School of Medicine, Başkent University Hospital, Sokak No: 6, 01250 Yuregir Adana, Turkey.
Akay
Hadi
H
Kavukçu
Sevket
S
Kutlay
Hakan
H
Cangir
Ayten Kayi
AK
Enön
Serkan
S
Kadilar
Cem
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001761:Bleomycin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D018700:Pleurodesis / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000008:administration & dosage; D013627:Talc / Q000008:administration & dosage*; D013752:Tetracycline / Q000008:administration & dosage; D019616:Thoracic Surgical Procedures / Q000379:methods; D016896:Treatment Outcome
D012597:Sclerosing Solutions; D001761:Bleomycin; D013627:Talc; D013752:Tetracycline