A Propensity-Matched Comparison of Pleurodesis or Tunneled Pleural Catheter in Patients Undergoing Diagnostic Thoracoscopy for Malignancy

Background. Patients with a suspected malignant pleural effusion occasionally require thoracoscopy to achieve a diagnosis. It is unclear whether chemical pleurodesis or the placement of a tunneled pleural catheter (TPC) that can be used for intermittent pleural drainage produces superior palliation, a shorter hospital stay, and less morbidity. This investigation compares these 2 treatment groups. Methods. Patients with a recurrent, symptomatic, pleural effusion suspected of having a malignant etiology who underwent a thoracoscopic exploration after at least 2 nondiagnostic thoracenteses were identified. Two patient groups were formed, comprised of patients who received either talc pleurodesis or a TPC at the conclusion of the procedure, using propensity matching. Patient demographics, length of stay, interval until the initiation of systemic therapy, need for further intervention for the pleural effusion, and procedural morbidity and mortality were collected and compared. Results. Over a 6-year period, 60 patients undergoing treatment were identified and propensity matched. No significant differences in mean age or palliation from their effusion were identified. However, the group treated with TPC realized a significantly shorter hospital stay and interval to systemic therapy for their malignancy as well as a lower rate of operative morbidity than patients undergoing talc pleurodesis. Conclusions. This investigation found that a TPC provided palliation of patients' malignant pleural effusions and freedom from reintervention equal to that of talc pleurodesis after thoracoscopy while resulting in a shorter mean length of hospital stay and interval to the initiation of systemic therapy. Lower rates of operative morbidity were also seen in the TPC treatment group. This method of palliation of a malignant pleural effusion should be considered when diagnostic thoracoscopy reveals a malignant pleural effusion. (C) 2013 by The Society of Thoracic Surgeons