Predictors of pleurodesis success after combined outpatient thoracoscopic talc poudrage and tunneled indwelling pleural catheter placement

Our plain-English summary of Predictors of pleurodesis success after combined outpatient thoracoscopic talc poudrage and tunneled indwelling pleural catheter placement, by M. Bani Salem, O. Al Zoubi, T. Maser, et al (Journal of Thoracic Disease, 2026).

The study

• Authors: M. Bani Salem, O. Al Zoubi, T. Maser, A. Iakovidis, M. Castro, K. Vijayan, P. Patel, H.J. Mehta
• Journal: Journal of Thoracic Disease
• Published: 2026;18(9):1011
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Combined ambulatory thoracoscopic talc poudrage and tunneled indwelling pleural catheter (TIPC) placement may facilitate early pleurodesis while preserving outpatient management for malignant pleural effusion (MPE). Predictors of pleurodesis success after this combined approach remain incompletely defined. In this study, we aimed to identify the predictors of successful pleurodesis after this combined approach among patients with expandable and non-expandable lung subgroups.

Methods: We performed a retrospective cohort study of 100 patients who underwent outpatient thoracoscopic talc poudrage with TIPC placement for MPE. Pleurodesis success was assessed at 3 and 6 months. Multivariable logistic regression was used to identify predictors of success among 97 evaluable patients. Additional analyses were performed in the non-expandable lung subgroup.

Results: Among 97 patients, 77 (79.4%) had expandable lungs. In multivariable analysis, lung expandability was independently associated with pleurodesis success at 3 months [odds ratio (OR), 15.2; 95% confidence interval (CI): 4.22-71.0; P<0.001] and 6 months (OR, 7.97; 95% CI: 2.07-33.9; P=0.003). Cancer group was associated with 3-month success in adjusted analysis (global P=0.046): compared with the lung/mesothelioma group, the other-malignancy group had lower odds of success (OR, 0.19; 95% CI: 0.04-0.73), whereas breast cancer did not differ significantly. No group difference persisted at 6 months (global P=0.46). Lung/mesothelioma-associated MPE had higher early pleurodesis success than other malignancy groups, but not at 6 months. In the non-expandable lung subgroup, complete visceral restriction, airway obstruction and adhesions were associated with lower 6-month pleurodesis success on univariate analysis.

Conclusions: Lung expandability was the strongest independent predictor of pleurodesis success after combined outpatient thoracoscopic talc poudrage and TIPC placement. Selected patients with non-expandable lung may still achieve successful pleurodesis.

© AME Publishing Company.

In plain English

This retrospective study reviewed 100 patients at a Florida hospital with cancer-related fluid around the lung (malignant pleural effusion). They had a planned outpatient procedure: thoracoscopic talc spraying plus a tunneled drainage catheter. Of 97 analyzed, 85 went home the same day; 12 were hospitalized. Asbestos exposure was not studied. Pleurodesis (sealing the space so the catheter could be removed) succeeded in 69.1% at 3 months and 86.6% at 6 months. A re-expandable lung was associated with higher odds of success at 3 months (odds ratio 15.2, 95% CI 4.22 to 71.0) and 6 months (7.97, 2.07 to 33.9). Age, sex, same-day discharge and performance status showed no significant association. Of 7 mesothelioma patients, 1 had a re-expandable lung; 4 succeeded by 3 months and 6 by 6 months. Their 3-month odds did not differ significantly from lung cancer's, an estimate the authors called imprecise. With non-expandable lungs, 9 of 10 patients with partial restriction and 4 of 10 with complete restriction succeeded by 6 months. The authors concluded expandability was the dominant predictor and selected non-expandable patients may still succeed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-center cohort study using electronic health records
• Who was studied: 100 patients with malignant pleural effusion at UF Health Shands Hospital, Gainesville, Florida, USA. 3 were excluded because they died without documented success, leaving 97 analyzed. Primary cancers were lung 34, breast 31, mesothelioma 7, and ovarian, gastrointestinal and genitourinary 8 each, plus 1 other. 20 patients had non-expandable lung. Study dates are not given.
• Exposure: Not an asbestos exposure study. The intervention was a planned outpatient medical thoracoscopy under moderate sedation with 4 g of sterile talc insufflated (talc poudrage), plus placement of a tunneled indwelling pleural catheter (PleurX). Patients needing extra observation or management were admitted. Predictors examined were age, sex, same-day discharge, lung expandability, ECOG performance status and cancer group.
• Main results:
  • Of the 97 analyzed patients, 87.6% (85) were discharged the same day. The remaining 12 (12.4%) were admitted, for complications or for a day of recovery.
  • Overall pleurodesis success among the 97 patients was 69.1% at 3 months and 86.6% at 6 months.
  • At 3 months, expandable lung was associated with higher adjusted odds of success (OR 15.2, 95% CI 4.22 to 71.0, P less than 0.001). Success was 79.2% (61/77) with expandable lung versus 30% (6/20) with non-expandable lung.
  • At 6 months, expandable lung remained associated with success (OR 7.97, 95% CI 2.07 to 33.9, P=0.003). Success was 71 of 77 (92.2%) with expandable lung versus 13 of 20 (65.0%) with non-expandable lung.
  • No statistically significant associations were found for age, sex, same-day discharge or performance status.
  • After adjustment, the other-malignancy group (ovarian, GI, GU, other) had lower odds of 3-month success than the pooled lung/mesothelioma group (15/25, 60.0%; OR 0.19, 95% CI 0.04 to 0.73, P=0.02). Breast cancer did not differ significantly. At 6 months cancer group was no longer associated with outcome (global P=0.46).
  • Mesothelioma patients rarely had expandable lung: 1 of 7 (14.3%), significantly fewer than in all other malignancies.
  • Unadjusted 3-month success was 57.1% (4/7) in mesothelioma versus 82.4% (28/34) in lung cancer. These crude differences across groups were not statistically significant. At 6 months, success was 85.7% in mesothelioma (6/7 in Table 2).
  • In a sensitivity analysis modelling mesothelioma separately, its adjusted odds of 3-month success did not differ significantly from lung cancer (OR 1.60, 95% CI 0.17 to 14.8, P=0.67).
  • In the non-expandable lung subgroup, complete restriction (10 patients) was compared with partial restriction (10 patients). Success with complete restriction was 1 of 10 at 3 months and 4 of 10 at 6 months; with partial restriction it was 5 of 10 and 9 of 10. On univariate analysis the 6-month OR was 0.07 (95% CI 0.003 to 0.63, P=0.03). In penalized (Firth) regression it was not statistically significant (OR 0.14, 95% CI 0.008 to 1.05, P=0.056).
  • In the non-expandable lung subgroup, pleural adhesions and airway obstruction showed a trend toward lower success but were not statistically significant.
  • Complications: two patients developed cellulitis at the catheter site, treated with antibacterial therapy. Two developed persistent air leaks requiring hospital admission.
• The authors' conclusion: The authors concluded that lung expandability was the dominant and only consistent independent predictor of pleurodesis success at 3 and 6 months. They also concluded that patients with non-expandable lung should not be universally excluded, since a meaningful proportion achieved pleurodesis when appropriately selected.
• Limitations the authors state:
  • Retrospective, single-center design
  • The non-expandable lung subgroup was small, giving less precise estimates.
  • The mesothelioma subgroup had only 7 patients, so the analysis separating mesothelioma from lung cancer was imprecise and exploratory.
  • The cancer-group association appeared only after adjustment, rested on few events, and needs confirmation in larger cohorts.
  • Several measures were not consistently available: pleural elastance, patient-reported outcomes, serial imaging, pleural fluid pH and LDH, molecular data, and tumor-burden grading. Post-procedural loculations and residual fluid were not systematically recorded.

Topics

Medical terms in this study, explained in our Lexicon: Pleurodesis, Talc, Indwelling Pleural Catheter, Pleural Effusion, Cohort Study, Odds Ratio, confidence interval, Mesothelioma.

Related studies

• Australasian Malignant PLeural Effusion (AMPLE)-3 trial: study protocol for a multi-centre randomised study comparing indwelling pleural catheter (±talc pleurodesis) versus video-assisted thoracoscopic surgery for management of malignant pleural effusion — D.B. Fitzgerald, C. Sidhu, et al. (2022)
• Clinical Factors Influencing Spontaneous Pleurodesis Success in Malignant Pleural Effusion in Patients With Indwelling Pleural Catheter — H.G. Kamil, A. AbiMusaAsa'ari, et al. (2026)
• Predictors of clinical use of pleurodesis and/or indwelling pleural catheter therapy for malignant pleural effusion — E.T.H. Fysh, S. Bielsa, et al. (2015)
• Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis — M. Yeung, E.W. Loh, et al. (2020)
• MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial — C. Matthews, C. Freeman, et al. (2019)
• Success rate of medical thoracoscopy and talc pleurodesis in malignant pleurisy: A single-centre experience — J. Leemans, C. Dooms, et al. (2018)

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