Talc pleurodesis versus indwelling pleural catheter for refractory pleural effusion: a prospective study of survival and complications

TL;DR

This study compares two treatments for persistent lung fluid buildup, finding that one offers quicker recovery while the other provides longer control.

Contribution

The study provides new evidence on the trade-offs between talc pleurodesis and indwelling catheters for pleural effusion management.

Findings

IPC resulted in shorter hospital stays but lower 12-month survival compared to TP.

TP achieved a 100% success rate in preventing fluid recurrence compared to 25.4% for IPC.

TP was associated with higher rates of chest pain and bleeding compared to IPC.

Abstract

The management of refractory pleural effusion presents a significant clinical challenge. This study aims to compare the outcomes of thoracoscopic talc pleurodesis (TP) and indwelling pleural catheter (IPC) insertion, focusing on survival, complications, and healthcare utilization, while accounting for baseline performance status.

We conducted a prospective cohort study in 2024 at a single tertiary care center, enrolling 101 patients with refractory pleural effusion. Patients were allocated to either the IPC group (n = 72, 71.3%) or the TP group (n = 29, 28.7%). Primary outcomes included overall survival, length of hospital stay, and total treatment duration. Secondary outcomes were pleurodesis success rate, effusion recurrence, and procedure-related complications. Multivariate analysis was performed to adjust for confounders including age, ECOG performance status, and etiology.

The IPC group had a significantly shorter median hospital stay (1 day vs. 7 days; p < 0.001). Unadjusted survival was significantly lower in the IPC group compared to the TP group at 12 months (13.3% vs. 62.1%; p < 0.001). However, after adjusting for ECOG performance status and age in a multivariate Cox regression, the treatment modality was no longer an independent predictor of mortality (HR 0.78, 95% CI 0.41–1.48; p = 0.45), whereas ECOG score remained a strong predictor (HR 1.65, 95% CI 1.32–2.06; p < 0.001). TP achieved a 100% pleurodesis success rate, compared to 25.4% for IPC (p < 0.001). IPC patients reported less chest pain (13.9% vs. 48.3%; p < 0.001) and bleeding (1.4% vs. 20.7%; p = 0.002).

A significant trade-off exists between the two procedures. IPC is associated with shorter hospitalization and fewer acute complications, while TP offers definitive effusion control. The observed survival difference in the TP group appears to be driven by the selection of fitter patients with better performance status for the more invasive procedure, rather than a direct therapeutic benefit of talc. Treatment decisions must be individualized, weighing patient prognosis and performance status.

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