Malignant pleural effusion: different treatments through countries

Introduction: Malignant pleural effusion (MPE) is typically recurrent and associated with significant morbidity. Thus, pleurodesis is often required to avoid the reaccumulation of pleural fluid. In Tunisia, pleural catheter and medical thoracoscopy are only available in few hospitals. In MTM hospital in Nabeul, we use the medical pleurodesis (MP) via a chest drain in addition to sclerotic agents like talc and Povidone-iodine. The purpose of this study is to evaluate the efficacy and the innocuity of MP for the management of MPE. Methods: We retrospectively studied the medical reports of 60 patients who underwent MP for MPE during the period between January 2014 and July 2018. Results: the mean age was 61±14 years. The population sex ratio was 1,61. The principal etiology of the MPE was the primary lung cancer (73%) followed by the breast cancer (13.3%). All patients had chest drainage. The average quantity of evacuated pleural fluid was 4020 ± 3200 ml. MP was done after lung re-expansion on average after 3.22 ± 2.1 days of pleural drainage. The sclerosant used were talc slurry for 56 patients (93.33%) and Povidone-iodine for 4 patients (6.66%). Intolerance such as chest pain, fever and dyspnea was observed in 20% of cases. The MP success rate was 75% and was similar for talc slurry and Povidone-iodine (75.8% vs 75.1%; p=0.8). Mean survival after pleurodesis was 139±114 days. There was no correlation between sclerosant used and survival (talc: 433 ± 123 days, Povidone-iodine 252±54 days;p=0.163). conclusion: Our study demonstrates that MP is effective and well tolerated in the majority of cases. This procedure may represent an interesting alternative to surgical thorascopy which is of a common use indeveloped countries.