Chemical pleurodesis as a therapeutic option in non-traumatic chylothorax: a scoping review

Non-traumatic chylothorax is a rare condition with heterogeneous etiology and significant morbidity and mortality. Most cases are associated with malignancy, accounting for approximately two-thirds of cases. Management remains challenging due to the lack of evidence-based guidelines. Initial treatment is typically conservative, including nutritional support and pleural drainage; however, failure rates are considerable, and optimal second-line strategies remain unclear. This scoping review aimed to evaluate the available evidence on the effectiveness and safety of chemical pleurodesis in patients with non-traumatic chylothorax.

A scoping review was conducted following established methodological frameworks and reported in accordance with PRISMA-ScR guidelines to map and synthesize the available evidence on the effectiveness and safety of chemical pleurodesis in patients with non-traumatic chylothorax. A comprehensive search of relevant databases was performed. Study selection was conducted using Rayyan, a web-based platform designed for systematic review screening, allowing independent and blinded assessment of titles and abstracts.

Chemical pleurodesis, particularly with talc, appears to be an effective and minimally invasive option for the management of non-traumatic chylothorax. Available evidence suggests high success rates in controlling chylous effusions in selected patients, with a favorable safety profile and low incidence of major complications. Despite these findings, its use remains limited, likely due to the scarcity of high-quality evidence and the lack of standardized criteria for patient selection and timing of intervention.

Chemical pleurodesis, especially talc pleurodesis, represents a viable therapeutic alternative in patients with non-traumatic chylothorax who fail conservative management. It should be considered as part of a multimodal treatment strategy. Further studies are needed to better define its indications, timing, and comparative effectiveness.