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Efficacy of talc pleurodesis for malignant and paramalignant pleural effusion: a retrospective analysis of 61 cases

Year 2020, Volume: 5 Issue: 2, 31 - 35, 14.05.2020

Hasan Oğuz Kapıcıbaşı

https://doi.org/10.22391/fppc.674215

Abstract

Introduction: Malignant-paramalignant effusions are common after malignancies. Treatment of malign-paramalignant pleural effusion is directed towards palliation of symptoms and improvement in quality of life. Chemical pleurodesis has been widely used to control malignant and para-malignant pleural effusion. The present study aims to reveal the effects of chemical pleurodesis on malignant and paramalignant pleural effusions commonly coexisting with malignant diseases.
Methods: 61 patients were retrospectively examined between October 2017 and December 2019. Drainage with 8F intrapleural catheter and chemical pleurodesis (sterile talc powder) were employed in 61 patients with malignant and/or paramalignant effusion. The patient group consisted of patients treated at the thoracic surgery service or consulted from other services. The patients demographics and data on their operated side (left/right), recurrence rate, length of postoperative hospital stay, and complications were extracted from their files.
Results: The sample consisted of 48 male (78.6%) and 13 female (21.3%) patients. The patients were between 22 and 82 years and the average age was 60.0 ± 13.2 years. 33 patients (54.0%) were operated on the right side, while 7 (11.4%) and 21 (34.4%) were operated bilaterally or on the left side, respectively. The most common cause of malignant and paramalignant pleural effusion was found to be lung cancer, accounting for 38 (62.2%) of the patients. Postoperative recurrence was observed in 15 (24.5%) patients. The ‎Mann-Whitney U test was used for skewed variables, and the Chi-Square test (or Fisher’s exact test) was used for ‎categorical variables. No significant difference was observed in terms of surgery side (p=0.676), gender (p=0.156) and malignant disease (p=0.979).The average length of hospital stay was 5.3 days.
Conclusions: The primary principle is to control the symptoms by removing the intrapleural effusion in the cases of malignant and paramalignant effusions. When recurrence rates were evaluated, intrapleural catheter drainage and chemical pleurodesis are an effective and safe method in selected patients.

Keywords

pleurodesis pleural effusion catheter

References

  • 1. Marel M, Zrustova M, Stasny B, Light RW. The incidence of pleural effusion in a well-defined region: Epidemiologic study in central Bohemia. Chest 1993;104:1486-9. https://doi.org/10.1378/chest.104.5.1486
  • 2. Heffner JE. Diagnosis and management of malignant pleural effusions. Respirology 2008;13:5-20. https://doi.org/10.1111/j.1440-1843.2008.01306.x
  • 3. Clive AO, Bhatnagar R, Psallidas I, Maskell NA. Individualised management of malignant pleural effusion. Lancet Respir Med 2015;3:505-6. https://doi.org/10.1016/S2213-2600(15)00183-6
  • 4. Dixit R, Agarwal K, Gokhroo A, Patil C, Meena M, Shah N. Diagnosis and management options in malignant pleural effusions. Lung India 2017;34:160-6. https://doi.org/10.4103/0970-2113.201305
  • 5. Penz E, Watt KN, Hergott CA, Rahman NM, Psallidas I. Management of malignant pleural effusion: Challenges and solutions. Cancer Manag Res 2017;9:229-41. https://doi.org/10.2147/CMAR.S95663
  • 6. Porcel JM. Pearls and myths in pleural fluid analysis. Respirology 2011;16:44-52. https://doi.org/10.1111/j.1440-1843.2010.01794.x
  • 7. Marel M, Fila L, Červená M. The differential diagnosis of pleural effusions. Vnitr Lek 2016;62:598-604. https://ncbi.nlm.nih.gov/pubmed/27627084
  • 8. Dikensoy O, Light RW. Alternative widely available, inexpensive agents for pleurodesis. Curr Opin Pulm Med 2005;11:340-4. https://doi.org/10.1097/01.mcp.0000166587.24127.91
  • 9. Tan C, Sedrakyan A, Browne J, Swift S, Treasure T. The evidence on the effectiveness of management for malignant pleural effusion: a systematic review. Eur J Cardiothorac Surg 2006;29:829-38. https://doi.org/10.1016/j.ejcts.2005.12.025
  • 10. Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline. Thorax 2010;2:32-40. https://doi.org/10.1136/thx.2010.136994
  • 11. Taghizadeh N, Fortin M, Tremblay A. US Hospitalizations for Malignant Pleural Effusions. Chest 2017;151:845-54. https://doi.org/10.1016/j.chest.2016.11.010
  • 12. Bibby AC, Dorn P, Psallidas I, Porcel JM, Janssen J, Froudarakis M,et al. ERS/EACTS statement on the management of malignant pleural effusions. Eur J Cardiothorac Surg 2018;52.1800349. https://doi.org/10.1183/13993003.00349-2018
  • 13. Rodríguez Suárez PM, Freixinet Gilart JL. Pleurodesis in the treatment of pneumothorax and pleural effusion. Monaldi Arch Chest Dis 2013;79:81-6. https://doi.org/10.4081/monaldi.2013.96
  • 14. Zarogoulidis K, Zarogoulidis P, Darwiche K, Tsakiridis K, Machairiotis N, Kougioumtzi I, et al. Malignant pleural effusion and algorithm management. J Thorac Dis 2013;5:413-9. https://doi.org/10.3978/j.issn.2072-1439.2013.09.04
  • 15. Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med 1994;120:56-64. https://doi.org/10.7326/0003-4819-120-1-199401010-00010
  • 16. Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev 2004;(1):CD002916. https://doi.org/10.1002/14651858.CD002916.pub2
  • 17. Davies HE, Lee YCG. Management of malignant pleural effusions: Questions that need answers. Curr Opin Pulm Med 2013;19:374-9. https://doi.org/10.1097/MCP.0b013e3283615b67
  • 18. Ferrer J, Villarino MA, Tura JM, Traveria A, Light RW. Talc preparations used for pleurodesis vary markedly from one preparation to another. Chest 2001;119:1901-5. https://doi.org/10.1378/chest.119.6.1901
  • 19. Maskell NA, Lee YCG, Gleeson FV, Hedley EL, Pengelly G, Davies RJO. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med 2004;170:377-82. https://doi.org/10.1164/rccm.200311-1579OC
  • 20. Laisaar T. Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis. Interact Cardiovasc Thorac Surg 2006;5:307-10. https://doi.org/10.1510/icvts.2005.118018
  • 21. Viallat JR, Rey F, Astoul P, Boutin C. Thoracoscopic talc poudrage pleurodesis for malignant effusions: A review of 360 cases. Chest 1996;110:1387-93. https://doi.org/10.1378/chest.110.6.1387
  • 22. Lee PP. Should thoracoscopic talc pleurodesis be the first choice management for malignant effusion? Yes/No. Chest 2012;142:15-7. https://doi.org/10.1378/chest.12-1085
  • 23. Steger V, Mika U, Toomes H, Walker T, Engel C, Kyriss T, et al. Who Gains Most? A 10-year experience with 611 thoracoscopic talc pleurodeses. Ann Thorac Surg 2007;83:1940 -5. https://doi.org/10.1016/j.athoracsur.2007.02.061
  • 24. Dresler CM, Olak J, Herndon JE, Richards WG, Scalzetti E, Fleishman SB, et al. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest 2005;127:909-15. https://doi.org/10.1378/chest.127.3.909
  • 25. Yildirim H, Metintas M, Ak G, Metintas S, Erginel S. Predictors of talc pleurodesis outcome in patients with malignant pleural effusions. Lung Cancer 2008;62:139-44. https://doi.org/10.1016/j.lungcan.2008.02.017
  • 26. Putnam JB, Walsh GL, Swisher SG, Roth JA, Suell DM, Vaporciyan AA, et al. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter. Ann Thorac Surg 2000;69:369-75. https://doi.org/10.1016/S0003-4975(99)01482-4
  • 27. Kaifi JT, Toth JW, Gusani NJ, Kimchi ET, Staveley-O'Carroll KF, Belani CP,et al. Multidisciplinary management of malignant pleural effusion. J Surg Oncol 2012;105:731-38. https://doi.org/10.1002/jso.22100

Talk plörodezisin malign ve paramalign plevral efüzyonda etkinliği: 61 olgunun retrospektif analizi

Year 2020, Volume: 5 Issue: 2, 31 - 35, 14.05.2020

Hasan Oğuz Kapıcıbaşı

https://doi.org/10.22391/fppc.674215

Abstract

Giriş: Malign ve paramalign effüzyonlar malignitelerden sonra yaygındır. Malign-paramalign plevral efüzyon tedavisi semptomların hafifletilmesine ve yaşam kalitesinin iyileştirilmesine yöneliktir. Kimyasal plörodez, malign ve paramalign plevral efüzyonu kontrol etmek için yaygın olarak kullanılmaktadır. Bu çalışmada malign hastalıklarla yaygın olarak birliktelik gösteren malign-paramalign plevral efüzyonlarda kimyasal plörodezisin etkisini saptamayı amaçladık.
Yöntem: 2017 Ekim ve 2019 Aralık yılları arasında 61 hasta retropektif olarak değerlendirilmiştir. 61 hastaya tarafımızdan malign ve/veya paramalign efüzyon nedeniyle 8F intraplevral kateter ile drenaj ve kimyasal plörodezis (steril talk pudrası) uygulandı. Hastalar göğüs cerrahisi servisinde tedavi edilen veya diğer servislerden konsultayon yapılan hastalardan oluşmaktaydı. Hastaların demografik verileri, operasyon tarafı (sol/sağ), rekürrens oranı, postoperatif hastanede kalış süresi ve komplikasyonları dosyalardan değerlerlendirildi.
Bulgular: Kırksekiz hasta (%78,6) erkek iken, 13 (%21,3) hasta kadındı. Yaş ortalaması 60,0 ± 13,2 olup yaş aralığı 22-82 yaş idi. 33 (%54,0) hasta sağ tarafından opere edilirken 7 (%11,4) hasta bilateral, 21 (%34,4) hasta sol tarafından opere edildi. En sık malign-paramalign plevral efüzyon nedeni 38 (%62,2) hasta ile akciğer kanseriydi. Postoperatif rekürrens 15 (%24,5) hastada izlendi. Niceliksel değişkenler için Mann-Whitney U testi ve kategorik değişkenler için Chi-Square testi (veya Fisher’ın exact test) kullanıldı. Cerrahi taraf (p = 0,676), cinsiyet (p = 0,156) ve malign hastalık (p = 0,979) açısından anlamlı fark gözlenmedi. Hastaneden ortalama yatış süresi 5,3 gündü.
Sonuç: Malign-paramalign efüzyonlarda intraplevral efüzyonun boşaltılarak semptomların kontrol altına alınması ana prensiptir. Rekürrens oranları değerlendirildiğinde, intraplevral kateter ile drenaj ve kimyasal plörodezis, seçilmiş hastalarda etkili ve güvenli bir yöntemdir.

Keywords

katater plörodez plevral effüzyon

References

  • 1. Marel M, Zrustova M, Stasny B, Light RW. The incidence of pleural effusion in a well-defined region: Epidemiologic study in central Bohemia. Chest 1993;104:1486-9. https://doi.org/10.1378/chest.104.5.1486
  • 2. Heffner JE. Diagnosis and management of malignant pleural effusions. Respirology 2008;13:5-20. https://doi.org/10.1111/j.1440-1843.2008.01306.x
  • 3. Clive AO, Bhatnagar R, Psallidas I, Maskell NA. Individualised management of malignant pleural effusion. Lancet Respir Med 2015;3:505-6. https://doi.org/10.1016/S2213-2600(15)00183-6
  • 4. Dixit R, Agarwal K, Gokhroo A, Patil C, Meena M, Shah N. Diagnosis and management options in malignant pleural effusions. Lung India 2017;34:160-6. https://doi.org/10.4103/0970-2113.201305
  • 5. Penz E, Watt KN, Hergott CA, Rahman NM, Psallidas I. Management of malignant pleural effusion: Challenges and solutions. Cancer Manag Res 2017;9:229-41. https://doi.org/10.2147/CMAR.S95663
  • 6. Porcel JM. Pearls and myths in pleural fluid analysis. Respirology 2011;16:44-52. https://doi.org/10.1111/j.1440-1843.2010.01794.x
  • 7. Marel M, Fila L, Červená M. The differential diagnosis of pleural effusions. Vnitr Lek 2016;62:598-604. https://ncbi.nlm.nih.gov/pubmed/27627084
  • 8. Dikensoy O, Light RW. Alternative widely available, inexpensive agents for pleurodesis. Curr Opin Pulm Med 2005;11:340-4. https://doi.org/10.1097/01.mcp.0000166587.24127.91
  • 9. Tan C, Sedrakyan A, Browne J, Swift S, Treasure T. The evidence on the effectiveness of management for malignant pleural effusion: a systematic review. Eur J Cardiothorac Surg 2006;29:829-38. https://doi.org/10.1016/j.ejcts.2005.12.025
  • 10. Roberts ME, Neville E, Berrisford RG, Antunes G, Ali NJ. Management of a malignant pleural effusion: British Thoracic Society pleural disease guideline. Thorax 2010;2:32-40. https://doi.org/10.1136/thx.2010.136994
  • 11. Taghizadeh N, Fortin M, Tremblay A. US Hospitalizations for Malignant Pleural Effusions. Chest 2017;151:845-54. https://doi.org/10.1016/j.chest.2016.11.010
  • 12. Bibby AC, Dorn P, Psallidas I, Porcel JM, Janssen J, Froudarakis M,et al. ERS/EACTS statement on the management of malignant pleural effusions. Eur J Cardiothorac Surg 2018;52.1800349. https://doi.org/10.1183/13993003.00349-2018
  • 13. Rodríguez Suárez PM, Freixinet Gilart JL. Pleurodesis in the treatment of pneumothorax and pleural effusion. Monaldi Arch Chest Dis 2013;79:81-6. https://doi.org/10.4081/monaldi.2013.96
  • 14. Zarogoulidis K, Zarogoulidis P, Darwiche K, Tsakiridis K, Machairiotis N, Kougioumtzi I, et al. Malignant pleural effusion and algorithm management. J Thorac Dis 2013;5:413-9. https://doi.org/10.3978/j.issn.2072-1439.2013.09.04
  • 15. Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med 1994;120:56-64. https://doi.org/10.7326/0003-4819-120-1-199401010-00010
  • 16. Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev 2004;(1):CD002916. https://doi.org/10.1002/14651858.CD002916.pub2
  • 17. Davies HE, Lee YCG. Management of malignant pleural effusions: Questions that need answers. Curr Opin Pulm Med 2013;19:374-9. https://doi.org/10.1097/MCP.0b013e3283615b67
  • 18. Ferrer J, Villarino MA, Tura JM, Traveria A, Light RW. Talc preparations used for pleurodesis vary markedly from one preparation to another. Chest 2001;119:1901-5. https://doi.org/10.1378/chest.119.6.1901
  • 19. Maskell NA, Lee YCG, Gleeson FV, Hedley EL, Pengelly G, Davies RJO. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size. Am J Respir Crit Care Med 2004;170:377-82. https://doi.org/10.1164/rccm.200311-1579OC
  • 20. Laisaar T. Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis. Interact Cardiovasc Thorac Surg 2006;5:307-10. https://doi.org/10.1510/icvts.2005.118018
  • 21. Viallat JR, Rey F, Astoul P, Boutin C. Thoracoscopic talc poudrage pleurodesis for malignant effusions: A review of 360 cases. Chest 1996;110:1387-93. https://doi.org/10.1378/chest.110.6.1387
  • 22. Lee PP. Should thoracoscopic talc pleurodesis be the first choice management for malignant effusion? Yes/No. Chest 2012;142:15-7. https://doi.org/10.1378/chest.12-1085
  • 23. Steger V, Mika U, Toomes H, Walker T, Engel C, Kyriss T, et al. Who Gains Most? A 10-year experience with 611 thoracoscopic talc pleurodeses. Ann Thorac Surg 2007;83:1940 -5. https://doi.org/10.1016/j.athoracsur.2007.02.061
  • 24. Dresler CM, Olak J, Herndon JE, Richards WG, Scalzetti E, Fleishman SB, et al. Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion. Chest 2005;127:909-15. https://doi.org/10.1378/chest.127.3.909
  • 25. Yildirim H, Metintas M, Ak G, Metintas S, Erginel S. Predictors of talc pleurodesis outcome in patients with malignant pleural effusions. Lung Cancer 2008;62:139-44. https://doi.org/10.1016/j.lungcan.2008.02.017
  • 26. Putnam JB, Walsh GL, Swisher SG, Roth JA, Suell DM, Vaporciyan AA, et al. Outpatient management of malignant pleural effusion by a chronic indwelling pleural catheter. Ann Thorac Surg 2000;69:369-75. https://doi.org/10.1016/S0003-4975(99)01482-4
  • 27. Kaifi JT, Toth JW, Gusani NJ, Kimchi ET, Staveley-O'Carroll KF, Belani CP,et al. Multidisciplinary management of malignant pleural effusion. J Surg Oncol 2012;105:731-38. https://doi.org/10.1002/jso.22100
There are 27 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Original Research
Authors

Hasan Oğuz Kapıcıbaşı 0000-0001-7275-1039

Publication Date May 14, 2020
Submission Date January 13, 2020
Acceptance Date March 8, 2020
Published in Issue Year 2020Volume: 5 Issue: 2

Cite

APA Kapıcıbaşı, H. O. (2020). Efficacy of talc pleurodesis for malignant and paramalignant pleural effusion: a retrospective analysis of 61 cases. Family Practice and Palliative Care, 5(2), 31-35. https://doi.org/10.22391/fppc.674215
AMA Kapıcıbaşı HO. Efficacy of talc pleurodesis for malignant and paramalignant pleural effusion: a retrospective analysis of 61 cases. Fam Pract Palliat Care. September 2020;5(2):31-35. doi:10.22391/fppc.674215
Chicago Kapıcıbaşı, Hasan Oğuz. “Efficacy of Talc Pleurodesis for Malignant and Paramalignant Pleural Effusion: A Retrospective Analysis of 61 Cases”. Family Practice and Palliative Care 5, no. 2 (September 2020): 31-35. https://doi.org/10.22391/fppc.674215.
EndNote Kapıcıbaşı HO (September 1, 2020) Efficacy of talc pleurodesis for malignant and paramalignant pleural effusion: a retrospective analysis of 61 cases. Family Practice and Palliative Care 5 2 31–35.
IEEE H. O. Kapıcıbaşı, “Efficacy of talc pleurodesis for malignant and paramalignant pleural effusion: a retrospective analysis of 61 cases”, Fam Pract Palliat Care, vol. 5, no. 2, pp. 31–35, 2020, doi: 10.22391/fppc.674215.
ISNAD Kapıcıbaşı, Hasan Oğuz. “Efficacy of Talc Pleurodesis for Malignant and Paramalignant Pleural Effusion: A Retrospective Analysis of 61 Cases”. Family Practice and Palliative Care 5/2 (September 2020), 31-35. https://doi.org/10.22391/fppc.674215.
JAMA Kapıcıbaşı HO. Efficacy of talc pleurodesis for malignant and paramalignant pleural effusion: a retrospective analysis of 61 cases. Fam Pract Palliat Care. 2020;5:31–35.
MLA Kapıcıbaşı, Hasan Oğuz. “Efficacy of Talc Pleurodesis for Malignant and Paramalignant Pleural Effusion: A Retrospective Analysis of 61 Cases”. Family Practice and Palliative Care, vol. 5, no. 2, 2020, pp. 31-35, doi:10.22391/fppc.674215.
Vancouver Kapıcıbaşı HO. Efficacy of talc pleurodesis for malignant and paramalignant pleural effusion: a retrospective analysis of 61 cases. Fam Pract Palliat Care. 2020;5(2):31-5.

Family Practice and Palliative Care       ISSN 2458-8865       E-ISSN 2459-1505