title: Improved quality of life in patients with malignant pleural effusion following videoassisted thoracoscopic talc pleurodesis. Preliminary results.
abstract: Malignant pleural effusion (MPE) is a common, debilitating complication of several types of advanced malignancy, which may significantly reduce the quality of life of patients. There are several options to treat MPE, including thoracentesis, placement of a long-term indwelling pleural catheter and chemical pleurodesis. The best treatment is still debated, but talc remains the agent of choice to achieve pleurodesis. Forty-six patients (28 men and 18 women; median age 67 years, range 47-82 years) with MPE related to different malignancies underwent video-assisted thoracoscopy talc pleurodesis. There were 26 (56.5%) patients with non-small cell lung cancer, 8 (17.4%) with breast cancer, 7 (15.2%) with pleural mesothelioma and 5 (10.9%) with other malignancies. The average operative time was 28±8 minutes, and the duration of chest tube drainage was 9.4±4.1 days. Side-effects were mild (temporary pain, fever for 2-3 days), affecting only three (12%) patients. Two patients (8%) died during hospitalization, due to progression of disease. Overall, pre- and postoperative Karnofsky performance index (KI) and Medical Research Council (MRC) dyspnea score were 62.1±12.2 vs. 71.3±13.2 (p=0.014), and 4.2±0.8 vs. 2.7±1.0 (p<0.001), respectively. A significant relationship between total amount of preoperative pleural effusion and both KI (R=-0.54, p=0.002) and MRC (R=0.64, p=0.0001) was found. No correlation (p=NS, log-rank test) was found between preoperative KI or MRC and underlying malignancy related to MPE. In conclusion, thoracoscopic large-particle talc pleurodesis is a feasible and effective treatment for MPE, significantly improving quality of life of patients.
authors.affiliation: Surgey I, S. Maria degli Angeli Hospital, Via Montereale 24, 33170 Pordenone, Italy. drsteba@tin.it
authors.forename: Stefano M M
authors.initials: SM
authors.lastname: Basso
authors.forename: Francesco
authors.initials: F
authors.lastname: Mazza
authors.forename: Bernardo
authors.initials: B
authors.lastname: Marzano
authors.forename: Davide A
authors.initials: DA
authors.lastname: Santeufemia
authors.forename: Giordano B
authors.initials: GB
authors.lastname: Chiara
authors.forename: Franco
authors.initials: F
authors.lastname: Lumachi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D018700:Pleurodesis / Q000379:methods*; D011788:Quality of Life; D013627:Talc / Q000008:administration & dosage*; D020775:Thoracic Surgery, Video-Assisted
chemical_list: D013627:Talc