Use of small-bore vs large-bore chest tubes for treatment of malignant pleural effusions.

Abstract

STUDY OBJECTIVE:

To evaluate the efficacy of small-bore (12 French vanSonnenberg) catheters compared with standard large-bore chest tubes in the drainage and sclerotherapy of malignant pleural effusions.

DESIGN:

Retrospective review.

SETTING:

An academic tertiary care hospital.

PATIENTS:

Adult patients with documented neoplasms and malignant pleural effusions, treated between 1986 and 1995.

INTERVENTION:

All patients included in the study underwent drainage of malignant pleural effusions either by large-bore chest tube or by ultrasound-guided small-bore catheter. After drainage, pleurodesis was performed.

RESULTS:

Outcome as defined by recurrence of effusion was determined by blinded examination of all postpleurodesis chest radiographs. We identified 58 cases of malignant pleural effusion in which small-bore catheters were used and 44 in which large-bore chest tubes were used. The majority of patients had breast (n = 56, 55%) or lung cancer (n = 29, 28%). The median age was 65 years. Fifty-nine patients were actively being treated with chemotherapy at the time of pleurodesis. The following sclerosing agents were used: talc, 27 (26%); tetracycline, 72 (70%); bleomycin, 2 (2%); and interferon, 1 (1%). Actuarial probabilities of recurrence at 6 weeks and 4 months were 45% and 53% for the small tubes vs 45% and 51% for the large tubes. Univariate and multivariate analyses failed to demonstrate that tube size had any influence on the rate of recurrence.

CONCLUSIONS:

We were unable to detect any major differences in outcomes with the use of either size of chest tube. Our study suggests that small-bore catheters may be effective in the treatment of malignant pleural effusions and deserve further evaluation in prospectively designed trials.

• Authors: W Parulekar, G Di Primio, F Matzinger, C Dennie, G Bociek
• Journal: Chest (Chest) Vol. 120 Issue 1 Pg. 19-25 (Jul 2001) ISSN: 0012-3692 [Print] United States
• PMID: 11451810 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Interferon Type I
• Sclerosing Solutions
• Bleomycin
• Talc
• Tetracycline

Topics

• Adult
• Aged
• Aged, 80 and over
• Bleomycin
• Breast Neoplasms (complications)
• Chest Tubes (adverse effects)
• Drainage (adverse effects, instrumentation)
• Female
• Humans
• Interferon Type I
• Lung Neoplasms (complications)
• Male
• Middle Aged
• Pleural Effusion, Malignant (mortality, therapy)
• Pleurodesis
• Probability
• Recurrence
• Retrospective Studies
• Sclerosing Solutions
• Sclerotherapy (adverse effects)
• Survival Rate
• Talc
• Tetracycline