Thoracoscopic Talc Insufflation Versus Doxycycline Pleurodesis For The Management Of Malignant Pleural Effusion.

Background: Malignant pleural effusions (MPEs) can be a complication of virtually any malignancy. Quality of life with MPE is often compromised due to debilitating symptoms like dyspnea, cough, orthopnea,chest pain or pressure. There are several approaches to MPE management, with the objective of each procedure to drain the pleural space and to relieve respiratory symptoms. If the MPE recurs after initial thoracentesis, several approaches can be taken for further control: repeat thoracentesis, placement of tunneled pleural catheter (TPC), tube thoracostomy with pleurodesis, or medical pleuroscopy with pleurodesis. Wide spread practice variation in performing pleurodesis would underscore the importance of appropriate clinical trials to determine the best clinical practices in performing pleurodesis. Objective of study: This study was performed to compare 2 widely used pleurodesis techniques, tube thoracostomy doxycycline pleurodesis and thoracoscopic talc insufflation, aiming to explore the effectiveness and safety of both procedures. Patients and methods: Thirty patients with documented MPE were selected and divided into 2 groups, subjects of group1 (20 patients) were managed by thoracoscopic talc insufflation and subjects of group 2 (10 patients) were managed by tube thoracostomy doxycycline pleurodesis. This study was conducted at Cairo University Hospitals. Approval of the Ethical Committee and written informed consent from all participants were obtained. Study period: January 2011 to May 2014. Results: Results of study showed that: - Both thoracoscopic talc insufflation and tube thoracostomy doxycycline pleurodesis achieved satisfactory success rates in controlling malignant pleural effusions with slightly higher success rate with talc insufflation. - Both techniques were not associated with major complications but frequency of complications was higher with doxycycline. Conclusion: - Thoracoscopic talc insufflation should be offered as the treatment of choice in controlling malignant pleural effusions provided that the required resources are available (sterile talc, thoracoscopes, skilled operators). - Tube thoracostomy doxycycline pleurodesis is a valuable alternative when thoracoscopic talc insufflation can not be done.