Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients

Surg Endosc. 2006 Jun;20(6):919-23. doi: 10.1007/s00464-005-0534-6. Epub 2006 May 2.


Background: The aim of this study was to analyze the results of pleurodesis for malignant pleural effusion performed by surgeons.

Patients and methods: A series of 273 patients with malignant pleural effusion underwent thoracoscopy with the aim of performing a palliative pleurodesis. There were 94 males (34.4%) and 175 females (64.1%), ranging in age from 15 to 94 years (mean age: 60.6 years). The effusion was on the right side in 136 patients (49.8%), on the left side in 110 (40.3%), and bilateral in 27 (9.9%). Thoracoscopy was performed under general anaesthesia in all patients. Pleural biopsy was performed in two thirds of the patients (70.7%). Pleurodesis was produced by instillation of 5g of sterile asbestos-free talc; the chest tube was left in place a minimum of 3 days. It was removed when fluid drainage was less than 200 ml/24 h. Patients were usually discharged the day after chest tube removal.

Results: There was no intraoperative mortality. Two patients (0.7%) had intraoperative complications; 17 (6.2%) underwent a bilateral pleurodesis, and 10 (3.7%) had a pericardiopleural window. In 32 patients (11.7%) no pleurodesis was done, either because the lung did not properly re-expand (5.2%), or because of suspected infection, e.g., false membranes (1.9%), or because of multiple adhesions (4.6%). Finally, only 241 patients (88.3%) had a talc poudrage at the time of thoracoscopy. Duration of postoperative pleural drainage ranged between 1 and 11 days (mean: 3.64 days). The postoperative hospital stay ranged from 2 to 21 days (mean: 7.1 days). Pleural empyema occurred in 4 patients (1.5%) and was lethal in one patient. The mean follow-up period was 8.39 (7.2 months, and 172 patients had regular follow up. In this group, there were 24 recurrences (14%), 12 of which were treated by repeat pleurodesis. The results were very good in 133 patients (77.3%), acceptable in 35 patients (20.3%), and there was a failure in 4 patients (2.4%).

Conclusions: Results of surgical thoracoscopy for malignant pleural effusion are good, with low morbidity. However, in debilitated patients, bedside talc slurry may be preferable.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Drainage
  • Female
  • Humans
  • Male
  • Middle Aged
  • Palliative Care*
  • Pleural Effusion, Malignant / drug therapy*
  • Pleural Effusion, Malignant / surgery*
  • Pleurodesis*
  • Postoperative Complications
  • Postoperative Period
  • Recurrence
  • Talc / therapeutic use
  • Thoracic Surgery, Video-Assisted*
  • Treatment Outcome


  • Talc