title: Thoracoscopic talc versus tunneled pleural catheters for palliation of malignant pleural effusions.
abstract: BACKGROUND
  A malignant pleural effusion (MPE) is a late complication of malignancy that affects respiratory function and quality of life. A strategy for palliation of the symptoms caused by MPE should permanently control fluid accumulation, preclude any need for reintervention, and limit hospital length of stay (LOS). We compared video-assisted thorascopic (VATS) talc insufflation with placement of a tunneled pleural catheter (TPC) to assess which intervention better met these palliative goals.
  
  
  METHODS
  We conducted a retrospective chart review of consecutive MPE at a single institution from 2005 through June 2011. Primary a priori outcomes were reintervention in the ipsilateral hemithorax, postprocedure LOS, and overall LOS.
  
  
  RESULTS
  One hundred nine patients with MPE were identified. Fifty-nine patients (54%) had TPC placed, and 50 (46%) were treated with VATS talc. Patients who underwent TPC placement had significantly fewer reinterventions for recurrent ipsilateral effusions than patients treated with VATS talc (TPC 2% [1 of 59], talc 16% [8 of 50], p=0.01). Patients treated with TPC had significantly shorter overall LOS (TPC LOS mean 7 days, mode 1 day; talc mean 8 day, mode 4 days, p=0.006) and postprocedure LOS (TPC post-procedure LOS mean 3 days, mode 0 days; talc mean 6 days, mode 3 days, p<0.001). Type of procedure was not associated with differences in complication rate (TPC 5% [3 of 59], talc 14% [7 of 50], p=0.18), or in-hospital mortality (TPC 3% [2 of 59], talc 8% [4 of 50], p=0.41).
  
  
  CONCLUSIONS
  TPC placement was associated with a significantly reduced postprocedure and overall LOS compared with VATS talc. Also, TPC placement was associated with significantly fewer ipsilateral reinterventions. Placement of TPC should be considered for palliation of MPE-associated symptoms.
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Center for Pleural Diseases, Swedish Cancer Institute, Swedish Medical Center, Seattle, Washington 98104, USA.
authors.forename: Ben M
authors.initials: BM
authors.lastname: Hunt
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Farivar
authors.forename: Eric
authors.initials: E
authors.lastname: Vallières
authors.forename: Brian E
authors.initials: BE
authors.lastname: Louie
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Aye
authors.forename: Eva E
authors.initials: EE
authors.lastname: Flores
authors.forename: Jed A
authors.initials: JA
authors.lastname: Gorden
mesh_terms: D000368:Aged; D057785:Catheters; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007327:Insufflation / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D010166:Palliative Care / Q000379:methods*; D016066:Pleural Effusion, Malignant / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018700:Pleurodesis / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013627:Talc / Q000008:administration & dosage*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology
chemical_list: D013627:Talc