Thoracoscopic tetracycline poudrage for pleurodesis in malignant pleural effusion

Abstract

Abstract Introduction Malignant pleural effusion (MPE) is a common problem and a real challenge to pulmonologists and oncologists. The optimum management of MPE depends on several factors, including patient’s symptoms and primary tumor status. Complete drainage and pleurodesis to prevent recurrence is usually needed. Tetracycline, talc, and bleomycin are considered the primary sclerosing agents. Aim of the study The aim of the study was to investigate the feasibility, effectiveness, and safety of thoracoscopically insufflated tetracycline powder to achieve pleurodesis in patients with MPE. Patients and methods Twenty patients with recurrent pleural effusion that proved to be malignant, or showing a picture highly suggestive of pleural malignancy at thoracoscopy, were included in the study. They were subjected to tetracycline poudrage (35 mg/kg) through medical thoracoscopy. Following discharge, patients were followed up at 3 and 6 months; the primary outcome was the measure of pleurodesis failure, defined as the reaccumulation of pleural fluid requiring further pleural intervention. Results Of the 20 patients included in this study, five were excluded from evaluation (two because of failure of lung re-expansion and three because of death within 2 months of the procedure). The overall success rate of thoracoscopic tetracycline poudrage pleurodesis in the 15 patients with MPE who completed the study was 86.6%. There was no recorded mortality or significant complications. Conclusion From this pilot study, we can conclude that thoracoscopy with tetracycline poudrage is an easy, safe, and effective method for performing pleurodesis in MPE.

Keywords

• malignant pleural effusion
• medical thoracoscopy
• pleurodesis
• tetracycline poudrage