Is full postpleurodesis lung expansion a determinant of a successful outcome after talc pleurodesis?
OBJECTIVE
To analyze and compare radiologic lung expansion after talc pleurodesis performed either by videothoracoscopy or chest tube and correlate it with clinical outcome. Secondary end points evaluated were as follows: clinical efficacy; quality of life; safety; and survival.


METHODS
Prospective randomized study that included 60 patients (45 women, 15 men; mean age, 55.2 years) with recurrent malignant pleural effusion between January 2005 and January 2008. They were randomized into the following two groups: video-assisted thoracic surgery (VATS) talc poudrage; and talc slurry (TS) administered through a chest tube. Lung expansion was evaluated through chest CT scans obtained 0, 1, 3 and 6 months after pleurodesis. Complications, drainage time, hospital stay, and quality of life (Medical Outcomes Study 36-item short form and World Health Organization quality-of-life questionnaires) were also analyzed.


RESULTS
There were no significant differences in preprocedure clinical and pathologic variables between groups. The immediate total (ie, > 90%) lung expansion was observed in 27 patients (45%) and was more frequent in the VATS group (60% vs 30%, respectively; p = 0.027). During follow-up, 71% of the patients showed unaltered or improved lung expansion and 9 patients (15%) needed new pleural procedures (VATS group, 5 recurrences; TS group, 4 recurrences; p = 0.999). No differences were found between groups regarding quality of life, complications, drainage time, hospital stay, and survival. Immediate lung expansion did not correlate with radiologic recurrence, clinical recurrence, or complications (p = 0.60, 0.15, and 0.20, respectively).


CONCLUSIONS
Immediate partial lung expansion was a frequent finding and was more frequent after TS. Nonetheless, no correlation between immediate lung expansion and clinical outcome was found in this study.


BACKGROUND
ClinicalTrials.gov Identifier: NTC00789087.
Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: rmterra@uol.com.br.
Ricardo Mingarini
RM
Terra
Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Jader Joel Machado
JJM
Junqueira
Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Lisete Ribeiro
LR
Teixeira
Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Francisco Suso
FS
Vargas
Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Paulo Manuel
PM
Pêgo-Fernandes
Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Fáabio Biscegli
FB
Jatene
D000368:Aged; D000704:Analysis of Variance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016066:Pleural Effusion, Malignant / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018700:Pleurodesis / Q000379:methods*; D011336:Probability; D011446:Prospective Studies; D011788:Quality of Life; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013627:Talc / Q000627:therapeutic use*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014109:Total Lung Capacity / Q000502:physiology*; D016896:Treatment Outcome
D013627:Talc