Use of small-bore catheter versus chest tube for talc slurry sclerotherapy in malignant pleural effusion

Shin, Ho Sik; Yook, Dong Seung; Kim, Hee Kyoo; Kim, Su Hong; Ok, Chul Ho; Jang, Tae Won; Jung, Maan Hong

Abstract

BACKGROUN: Talc sclerotherapy is widely used for symptomatic malignant pleural effusion. The object of this study was to evaluate the outcome of talc slurry sclerotherapy, and to compare the efficacy of the small-bore catheter with that of chest tube in sclerotherapy of malignant pleural effusion.
METHODS
From January 2000 to May 2002, 37 patients with malignant pleural effusion were enrolled and randomized to the chest tube (28F, n=17) or the small-bore catheter (14F, n=20) groups. The majority of patients had lung cancer (n=33, 89%) and two had breast cancer. The median age was 55 years. After verification of reexpansion of lung on chest radiogram. five grams of purified asbestos-free talc in 50 mL of normal saline were used for talc slurry sclerosis. The success of the procedure was defined as daily drainage below 50 mL within 1 week after talc slurry instillation. Side effects of the sclerotherapy and complications were compared by the drainage method and the recurrence rates in 3, 6 and 9 months were evaluated.
RESULTS
Initial success rates of sclerotherapy by small-bore catheter was 80% and that of chest tube was 70.5% (p=0.07). The most common early complication after talc slurry instillation was pain followed by fever. But procedure related mortality or respiratory failure was not developed. The mean duration of drainage by small-bore catheter was 8.2days and that of chest tube was 8.8days (p=0.60). But the catheter-related complications of pain, subcutaneous infection and, emphysema were significantly less in the small-bore catheter group than the chest tube groups (15% vs 88%, 5% vs 23.5%, 0% vs 17.5% respectively) There was no statistically significant difference between the two groups in the recurrence rate at 3 months (37.5% for the small-bore catheter vs. 33.3% for the chest tube, p=0.45), 6 months (56.3% vs. 58.3%, p=0.75), and 9 months (87.5% vs. 83.3%, p=0.65).
CONCLUSION
Talc slurry sclerotherapy via chest tube or small-bore catheter was a safe and effective method for the treatment of symptomatic malignant pleural effusion. But small-bore catheters are preferred to the chest tube in the sense of catheter-related complications.