Predictors of pleurodesis success after combined outpatient thoracoscopic talc poudrage and tunneled indwelling pleural catheter placement.

Abstract

Background: Combined ambulatory thoracoscopic talc poudrage and tunneled indwelling pleural catheter (TIPC) placement may facilitate early pleurodesis while preserving outpatient management for malignant pleural effusion (MPE). Predictors of pleurodesis success after this combined approach remain incompletely defined. In this study, we aimed to identify the predictors of successful pleurodesis after this combined approach among patients with expandable and non-expandable lung subgroups.

Methods: We performed a retrospective cohort study of 100 patients who underwent outpatient thoracoscopic talc poudrage with TIPC placement for MPE. Pleurodesis success was assessed at 3 and 6 months. Multivariable logistic regression was used to identify predictors of success among 97 evaluable patients. Additional analyses were performed in the non-expandable lung subgroup.

Results: Among 97 patients, 77 (79.4%) had expandable lungs. In multivariable analysis, lung expandability was independently associated with pleurodesis success at 3 months [odds ratio (OR), 15.2; 95% confidence interval (CI): 4.22-71.0; P<0.001] and 6 months (OR, 7.97; 95% CI: 2.07-33.9; P=0.003). Cancer group was associated with 3-month success in adjusted analysis (global P=0.046): compared with the lung/mesothelioma group, the other-malignancy group had lower odds of success (OR, 0.19; 95% CI: 0.04-0.73), whereas breast cancer did not differ significantly. No group difference persisted at 6 months (global P=0.46). Lung/mesothelioma-associated MPE had higher early pleurodesis success than other malignancy groups, but not at 6 months. In the non-expandable lung subgroup, complete visceral restriction, airway obstruction and adhesions were associated with lower 6-month pleurodesis success on univariate analysis.

Conclusions: Lung expandability was the strongest independent predictor of pleurodesis success after combined outpatient thoracoscopic talc poudrage and TIPC placement. Selected patients with non-expandable lung may still achieve successful pleurodesis.