Retrospective evaluation of effectiveness and safety of local anaesthetic thoracoscopy compared with blind chest drain pleurodesis

Aim: To retrospectively evaluate effectiveness and safety of local anaesthetic medical thoracoscopy and talc poudrage (TP) compared with chest drain and talc slurry pleurodesis (TS) in a district general hospital (DGH) without onsite thoracic surgery backup. Methods: Data was collected between July 2007 and February 2010 using multidisciplinary team minutes and pharmacy records. All patients with malignant effusions who had treatment and had follow up were included. Patients with no diagnosis or follow up and those who did not have TS/TP were excluded. Results: 104 patients were identified, 42 patients met inclusion and exclusion criteria. Mean age in TS vs. TP was 71.5/71.4 years. Pleurodesis success rate in TS vs. TP was 22.2/87.5%. In the TS group, 75% of patients with a successful pleurodesis were receiving chemotherapy. The average time from pleurodesis to death, TS vs. TP was 201.6/359.6 days. Of the 14 failures in the TS group 64.2% (9/14) died within 6 months and 28.6% (4/14) had mesothelioma. In the TP group 79.1% (19/24) were alive at 6 months and 66.6% (2/3) of the failures had mesothelioma. Two of the 3 patients with failed TP were recruited in an ongoing trial involving a drug therapy and pleurodesis success rates. Mean follow up, TS vs. TP was 67.7/200.3 days. No serious complications were documented in either group. Conclusion: To the best of our knowledge this is the first local anaesthetic thoracoscopy data comparing with TS in a DGH setting. The TP group has a success rate on par with published data. Based on this data we may conclude that local anaesthetic TP is effective and safe in patients with reasonable performance status.