Objective

Malignant pleural effusions are most often managed with talc pleurodesis following drainage to dryness, to prevent recurrence of the effusion. Current BTS guidelines suggest 4-5 grams of talc when performing a pleurodesis with slurry, however there are no guidelines regarding dose when using a talc poudrage. We aim to compare clinical outcomes of using varying doses of talc poudrage for suspected malignant pleural effusion, when insufflated during video assisted thoracoscopic surgery (VATS).

Methods

Retrospective data was collected on VATS talc pleurodesis performed at our centre between January 2012-January 2015. We used our electronic documentation system to obtain data. Our primary outcomes were repeat intervention and incidence of empyema. Baseline characteristics, procedural complications and mortality were recorded. We split the doses of talc used into ≤4 grams and >4 grams. Patients having a concurrent procedure or who were unable to be followed up were excluded.

Results

Our study included 75 patients, who received ≤4 grams (N=56) or >4 grams (N=19) of sterile talc. Within these groups, repeat intervention rates were 14.3% and 10.5% respectively (p=0.338). There were 3 incidences of empyema, with no statistical significance between the differing doses. 85.3% were subsequently confirmed to have an underlying malignant process, the majority (51.6%) being mesothelioma. 60% of those requiring repeat intervention had the underlying diagnosis of mesothelioma.

Conclusion

In patients undergoing talc poudrage for suspected malignant pleural effusion, no statistically significant difference has been demonstrated in repeat intervention rates or rates of empyema between those receiving ≤4 grams and those receiving >4 grams of talc. We have noted that recurrence of effusion post talc pleurodesis is more common in those with an underlying diagnosis of mesothelioma.