Introduction Malignant pleural effusions (MPE) are a frequent consequence of advanced malignancy, associated with poor prognosis. The British Thoracic Society endorse intercostal drainage and talc pleurodesis as first line management of MPE in patients without evidence of trapped lung. However, talc pleurodesis is unsuccessful in 10%–40% of cases, with implications in relation to cost and morbidity.¹ Yet ambiguity exists regarding the factors affecting success in MPE talc pleurodesis.

Aim This study aims to investigate the predictive factors relating to successful talc pleurodesis in MPE and the impact of a positive outcome on patient mortality.

Methodology Retrospective analysis of patients admitted for management of MPE to the Belfast City Hospital between September 2015 – October 2016 was conducted. Demographic and clinical data relating to drain size, volume of fluid drained and grade of the doctor performing talc pleurodesis was collected. Survival at 18 months post procedure was reviewed through electronic patient records. A positive outcome was defined as successful pleurodesis with the lack of recurrence of pleural effusion.

Results Twenty-seven patients were identified (♂/♀: 40.8/59.2%; age 72.4+/-12.3 years). Two thirds (n=18) received pleurodesis with a 44.4% success rate (n=8). Pleurodesis was precluded in one third of patients (n=9) with displaced and blocked drains the predominant causative factor (n=4). In those receiving talc pleurodesis, drain size (12 F vs 18 F) was not a predictive factor of positive outcomes. Similarly, the grade of doctor performing talc pleurodesis did not affect efficacy. However, compared to 18 F drains, 12 F drains were associated with a significant complication rate precluding pleurodesis (p=0.02). Critically, achieving a successful outcome with talc pleurodesis was associated with improved 18 month mortality (p=0.004).

Conclusion Promoting the exclusive utilisation of 18 F drains in the management of MPE could potentially alleviate the propensity for intercostal drain failure to preclude talc pleurodesis, conceivably improving patients’ short term mortality.

Reference

1. Santos PS, Marques MA, Cruz C, Monteiro H, Fradinho F. Predictors of talc slurry pleurodesis success in patients with malignant pleural effusions. Revista Portuguesa de Pneumologia2017;23(4):216–220.