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Ann Thorac Surg 1996;62:1658
© 1996 The Society of Thoracic Surgeons

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Invited Commentary

Invited Commentary

Department of Surgery, Louisiana State University School of Medicine, 1542 Tulane Ave, New Orleans, LA 70112

See also page 1655.

The very nice study by Dr Yim and his associates attempts to evaluate the optimal route of administration of talc for pleurodesis. Talc has been demonstrated by numerous studies to be effective in 90% or better of malignant effusions whether given by insufflation or by injection through a chest tube. With this high degree of effectiveness, a very large number of cases would be required to demonstrate any significant difference. Thus, it is not surprising that in this relatively small number of patients (57) no differences would be demonstrated. Yim and associates found the hospital stay to be the same in both groups and were not able to evaluate costs in their state hospital system.

My colleagues and I use both methods, and in more than 110 cases of slurry injection for both malignant and benign effusions, the very few failures have usually been because we used the slurry before adequate drainage had been achieved (less than 100 mL/day) or there were undetected loculations. We have modified our former instillation technique by increasing the volume of the slurry with the same 5 g of purified talc to more than 200 mL to assure rapid coating of all pleural surfaces. We have used thoracoscopic talc insufflation in all cases where thoracoscopic visualization was needed for biopsy, adhesiolysis, or some other interventional procedure. Here again our results with achieving pleurodesis with talc insufflation have been close to 100%.

We continue to use tube instillation in general because it is a much simpler bedside technique that does not require anesthesia and is tremendously cheaper in our hospitals than video thoracoscopy. We believe video thoracoscopy should be used only for requisite diagnostic or therapeutic procedures rather than just instillation of the talc.

Related Article

Thoracoscopic Talc Insufflation Versus Talc Slurry for Symptomatic Malignant Pleural Effusion

Anthony P. C. Yim, Anthony T. C. Chan, Tak Wai Lee, Innes Y. P. Wan, and Jonathan K. S. Ho
Ann. Thorac. Surg. 1996 62: 1655-1658. [Abstract] [Full Text]

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Watts R. Webb Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Webb, W. R. Search for Related Content PubMed Articles by Webb, W. R. Related Collections Related Article