Small-bore versus large-bore catheters for talc pleurodesis of malignant pleural effusion: a tertiary hospital experience

Background: Malignant Pleural Effusion (MPE) is a complication of advanced malignancy occurring commonly in patients with lung cancer, lymphoma and breast cancer. Pleurodesis is often used to prevent re-accumulation of fluid and to help respiratory status. The size of the catheter (small versus large) to be used for pleurodesis, however, continues to be debated. Objective: To describe a tertiary hospital experience in patients requiring pleurodesis for malignant pleural effusion, with a comparison of small-bore catheter and large-bore catheter outcomes. Methods: Retrospective chart abstraction study of patients who received chemical pleurodesis with talc via catheter for malignant pleural effusions between 1 January 2012 and 31 December 2014 in our hospital. Small-bore (8-10 F) versus large-bore (28-32 F) catheter outcomes of interest were length of stay (LOS) post-catheterization and total LOS. Results: A total of 185 patients were included in the study, of whom 67 (36.2%) received a small-bore catheter and 118 (63.8%) a large-bore catheter groups, respectively. Lung cancer was the most common primary malignancy. Using propensity-score matched analyses, post-catheterization LOS was shown to be significantly shorter in the small-bore catheter group (1.8 d; p<0.001), however, total LOS was not different between the two groups (p=0.89). The pain VAS score was significantly lower in small bore catheter group than in large bore catheter group (p<0.001). The success rates were similar in the two groups (p=0.68). Conclusion: In our study post-procedure length of hospital stay is shorter when talc pleurodesis is conducted via small-bore catheter as compared to large-bore catheter. The success rates of pleurodesis were found to be similar regardless of the type of tube inserted. In addition, the pain VAS score was significantly lower in small bore catheter group than the large one