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Thoracoscopic talc pleurodesis for malignant pleural effusion
David Love1, Dean White, George Kiroff
1Division of Surgery, St John of God Hospital, Ryrie Street, Geelong, Victoria 3220, Australia.
ANZ Journal of Surgery
|January 22, 2003
Summary
Managing malignant pleural effusion (MPE) with thoracoscopy and talc insufflation offers palliative care for cancer patients. This approach provides satisfactory symptom control with acceptable morbidity and no early mortality.
Area of Science:
- Thoracic Surgery
- Palliative Care
- Oncology
Background:
- Malignant pleural effusion (MPE) is a common, distressing end-of-life condition for cancer patients.
- Managing MPE presents surgical challenges in providing effective palliation with minimal impact on patient time.
Purpose of the Study:
- To evaluate the outcomes of thoracoscopic talc insufflation for managing malignant pleural effusion.
- To assess the efficacy and safety of this minimally invasive technique in palliative care.
Main Methods:
- Retrospective review of 66 malignant pleural effusions (MPE) in 61 patients treated between 1995 and 2000.
- Standard two-port thoracoscopy with single-lung anesthesia and talc insufflation.
- Outcomes assessed via practitioner/patient contact, focusing on effusion recurrence and survival.
Main Results:
- Complete follow-up for 60 MPE (55 patients). Common primaries: breast, lung, mesothelial.
- Complete effusion control achieved in 52% of cases until death.
- Median survival was 220 days; 30-day mortality was 0%.
Conclusions:
- Complete, permanent control of malignant effusions is challenging.
- Thoracoscopy with talc insufflation yields satisfactory results with acceptable morbidity and no early mortality.
- Pleural space inspection, adhesion lysis, and complete lung expansion likely contribute to successful outcomes.