Early pleurodesis at initial chest tube drainage for malignant pleural effusion: a retrospective single-center study

Malignant pleural effusion (MPE) impairs the quality of life and it may interrupt systemic cancer therapy. In Japan, indwelling pleural catheters are unavailable, and the optimal timing for pleurodesis remains unclear. We examined whether pleurodesis performed during the initial chest tube drainage for MPE was associated with fewer reinterventions.

We retrospectively reviewed the patients who underwent initial chest tube drainage for MPE at the Osaka International Cancer Institute (January 2019-June 2025). The re-intervention analysis included patients with a performance status of 0-1 who continued systemic therapy after drainage. Re-intervention within 180 days was compared between the pleurodesis and non-pleurodesis groups. Propensity score matching (1:1) and competing risk analyses (death as a competing event) were performed.

Pleurodesis was performed in 159 patients (67%); pleurodesis-related complications occurred in 17.6% of patients, including empyema in two patients (1.3%). Among 117 eligible patients, re-intervention within 180 days occurred in 11/89 (12.4%) and 10/28 (35.7%) patients in the pleurodesis and non-pleurodesis groups, respectively. In the matched cohort (26 per group), pleurodesis was associated with a lower cumulative incidence of re-intervention (Gray's test, p = 0.033) and a lower subdistribution hazard (sHR 0.215, 95% CI 0.0468-0.9887; p = 0.048).

In patients with MPE requiring initial chest tube drainage, pleurodesis at the time of drainage may be associated with fewer reinterventions, although residual confounding remains.