Local Iodine Pleurodesis Versus Thoracoscopic Talc Insufflations In Recurrent Malignant Pleaural Effusion: A Prospective Randomized Control Trial

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Journal Title, Volume, Page: 
Eur J Cardiothorac Surg. 2011 Aug; 40(2):282-286
Year of Publication: 
2011
Authors: 
Haj-Yahia S.
Ananiadou OG
Redmond K
Tawfeek N
Meshref M
Zeid AA
Mohsen TA
Preferred Abstract (Original): 
Objective: To compare the efficacy, safety, and outcome of thoracoscopic talc poudrage (TTP) versus povidone–iodine pleurodesis (PIP) through a thoracostomy tube as a palliative treatment of pleural effusion due to metastatic breast carcinoma (MBC). Methods: A total of 42 MBC patients were prospectively enrolled in a randomized controlled trial. Twenty-two patients received TTP (group A), whereas 20 patients (group B) underwent pleurodesis by instilling povidone–iodine through a thoracostomy tube, as a bedside procedure. Results: The mean age was 48.2 ± 9.9 (range: 29–64) years and 50.2 ± 7 (range: 32–62) years for groups A and B, respectively (p = ns). At presentation, all patients had moderate to severe dyspnea, New York Heart Association (NYHA) > II and Medical Research Council (MRC) dyspnea scale 3–5. Morbidity in both groups was low. Post-procedure analgesic requirements due to severe pleuritic chest pain were higher in group A (18% vs 0%, p = 0.2). Four patients in group A (18%) and one in group B (5%) were febrile (>38 °C) within 48 h of the procedure. Both groups achieved good symptom control, with improvement in MRC dyspnea scale (1–3). There were no in-hospital deaths. Post-procedure hospital stay was lower in group B (p = 0.009). The mean progression-free interval was 6.6 (range 3–15) months. At follow-up (mean: 22.6 (range: 8–48) months), recurrence of significant pleural effusion requiring intervention was noted in two and three patients in group A and group B, respectively (p = ns). Conclusion: Povidone–iodine can be considered as a good alternative to TTP to ensure effective pleurodesis for patients with malignant pleural effusion due to MBC. The drug is available, cost effective and safe, can be given through a thoracostomy tube and can be repeated if necessary.
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