Management of recurrent malignant pleural effusions. The complementary role talc pleurodesis and pleuroperitoneal shunting

Cancer. 1995 Feb 1;75(3):801-5. doi: 10.1002/1097-0142(19950201)75:3<801::aid-cncr2820750309>;2-h.


Background: Recurrent pleural effusions in patients with advanced cancer is a common problem that causes significant morbidity and can negatively affect patients' quality of life for their remaining months. Several palliative treatment options are available.

Methods: The results of a 10-year experience with 180 patients referred for the surgical palliation of their condition were retrospectively reviewed. Their mean age was 60 years (range, 20-90 years). One hundred and thirty-four patients (74%) had been treated before referral with one or more of the following modalities: repeated needle thoracocentesis (87 patients), tube thoracostomy (24 patients), chemical or biologic pleurodesis (22 patients), and pleurectomy (1 patient). One hundred and seventeen patients demonstrated full lung expansion at thoracoscopy/mini-thoracotomy and underwent talc pleurodesis, whereas the other 63 patients had the "trapped lung syndrome" and required the insertion of a pleuroperitoneal shunt (Denver, Biomedical, Inc).

Results: There were no intraoperative deaths and the early death rate was 5.9% for the talc pleurodesis group and 3.2% for the group that received shunts. The mean hospital stay for the patients receiving talc and shunts was 7.3 days (range, 3-15 days) and 5.9 days (range, 2-12 days), respectively. Follow-up data were available in 60% of the patients and showed that effective palliation was achieved in more than 95% of patients in each group. There were eight patients (12%) with blocked shunts (five requiring replacement or renovation and three requiring removal and open drainage) at 1 week to 4 months after insertion. Two patients (one from each group) required one further episode of treatment by thoracocentesis. The median survival for the talc and shunt groups was 4.9 months (range, 1-36 months) and 5.4 months (range, 1-53 months). Patients with effusions because of secondary breast carcinoma or lymphomas survived the longest.

Conclusion: In patients with malignant pleural effusions in whom pleurodesis is precluded by limited lung expansion, effective palliation can be achieved by pleuro-peritoneal shunt insertion.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Drainage* / instrumentation
  • Drainage* / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Palliative Care
  • Pleural Effusion, Malignant / surgery
  • Pleural Effusion, Malignant / therapy*
  • Pleurodesis*
  • Retrospective Studies
  • Talc / administration & dosage*


  • Talc