Thoracoscopic tetracycline poudrage for pleurodesis in malignant pleural effusion

Abstract

Introduction: Patients with malignant pleural effusion (MPE) are usually symptomatic .Dyspnea is the commonest symptom. Treatment options are determined by several factors including symptoms, primary tumour type, and lung re-expansion following thoracentesis. Management through complete drainage and instillation of a sclerosant to promote pleurodesis and prevent recurrence is usually effective. Tetracycline, talc and bleomycin are considered the primary sclerosing agents. Aim of the study: To investigate the feasibility, effectiveness and safety of thoracoscopically insufflated tetracycline powder in achieving pleurodesis in patients with (MPE). Patients and Methods: Twenty patients with recurrent MPE were included in this study. They were subjected to tetracycline poudrage (35 mg/kg) through medical thoracoscopy, with subsequent follow up at 3 and 6 months; the primary outcome was the measure of pleurodesis failure, defined as the reaccumulation of pleural fluid requiring further pleural intervention. Results: Twenty patients were included in the study. Five patients were excluded from evaluation for different reasons. The overall success rate of the 15 patients with malignant pleural effusion was 86.6%. No recorded mortality or significant complications except for one patient who developed empyema following prolonged drainage. Two patients (13%) had low grade fever that subsided within 48 hours, 4 patients (26%) described chest pain that disappeared with 3 days. In 2 patients (13%), the drainage was prolonged for more than 7 days. Conclusion: From this pilot study, we conclude that thoracoscopic tetracycline poudrage is an easy method, safe, and effective in achieving pleurodesis in MPE.