CHEST
Volume 119, Issue 3, March 2001, Pages 801-806
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Clinical Investigations
Thoracoscopy Talc Poudrage: A 15-Year Experience

https://doi.org/10.1378/chest.119.3.801Get rights and content

Objectives:

To review our experience with thoracoscopyand talc poudrage during the previous 15 years with regards toefficacy, side effects, morbidity, and mortality.

Methods:

Six hundred fourteen consecutive patients (58.6%female; mean age, 54.5 years) underwent thoracoscopy with talc poudragefrom August 1983 to May 1999. Of these, 457 patients had malignantpleural effusions, 108 patients had benign pleural effusions, and 49patients had spontaneous pneumothorax.

Results:

Sixty-four patients were excluded from evaluation for efficacy: 30patients (4.9%) because the lung did not expand at the time of theprocedure and 34 patients (5.5%) because they died with in 30 days of the thoracoscopy. All exclusions were in the malignant group. Theoverall success rate of the 393 patients with malignant pleuraleffusions was 93.4%, while the overall success for the 108 patientswith benign effusions was 97%, although 7 patients (7%) with benigneffusions required a second thoracoscopy. The success rate with pneumothorax was 100%. Major morbidity included empyema in 4%,reexpansion pulmonary edema in 2.2%, and respiratory failure1.3%.

Conclusion:

Thoracoscopy with talc poudrage iseffective in producing a pleurodesis in malignant and benign pleuraleffusion and in spontaneous pneumothorax. However, it should be notedthat the insufflation of talc has a systemic distribution associatedwith a low rate of morbidity and perhaps does induce ARDS, which issometimes fatal in a small percentage of patients. Because of theseside effects, the search for a better agent should becontinued.

Section snippets

Materials and Methods

This series consists of 614 consecutive patients (254 male,41.4%; 360 female, 58.6%; mean age, 54.5 years; range, 1 to 96 years)who underwent a diagnostic and/or therapeutic thoracoscopy with talcpoudrage pleurodesis from August 1983 to May 1999. According to thediagnosis, 157 patients (25.6%) had benign diseases (49 with pneumothorax and 108 with pleural effusions) and 457 patients (74.4%)had malignant pleural effusions. The patients with cancer wereclassified into two groups: breast cancer

Results

Sixty-four patients were excluded, including 30 patients (4.9%)because their lung did not expand at the time of the procedure, and 34patients (5.5%) because they died with in 30 days; 550 patients wereincluded in the final study. The differential diagnosis of the 105benign pleural effusions and the primary site of the 393 malignantpleural effusions included in the study are shown in Table 2.

Thoracoscopy with talc insufflation was very effective in preventingrecurrent pneumothorax (Table 1).

Discussion

Talc is believed to be one of the safest, cheapest, and mosteffective agents for promoting pleural symphysis. We were initiallyimpressed by the article of Frankel and coworkers,15 whoin 1961 published the results of an experimental study comparing theability of different chemical irritants to produce pleural symphysis. They concluded that talc produced the most homogenous and denseadhesions. Twenty years later, Weissberg16 summarized hisexperience with talc insufflation for pleurodesis in

ACKNOWLEDGMENT

We acknowledge and appreciate the assistance of Drs. Stephano J. G. Pereira and Andrea Oliveira Quim, in the review of the literature and information from patients' charts.

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