Tube Thoracotomy and Chemical Pleurodesis versus Thoracoscopy in Recurrent Malignant Pleural Effusion

Rayan, Amr; Elshazli, Mohamed

doi:10.21608/svuijm.2025.408184.2225

Tube Thoracotomy and Chemical Pleurodesis versus Thoracoscopy in Recurrent Malignant Pleural Effusion

Document Type : Original research articles

Authors

Amr Rayan ¹
Mohamed Elshazli ²

¹ Cardiothoracic Surgery Department , Faculty of Medicine, Alexandria University, Alexandria, Egypt.

² Oncology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

10.21608/svuijm.2025.408184.2225

Abstract

Background: Malignant pleural effusion (MPE) is a debilitating complication of advanced cancers, significantly impacting patients' quality of life. While drainage with pleurodesis is well-established, the optimal approach—bedside chest tube pleurodesis versus thoracoscopic pleurodesis—remains debated.
Objectives: This study aimed to compare clinical outcomes, patient comfort, and efficacy between chest tube drainage with povidone-iodine pleurodesis and thoracoscopic pleurodesis in MPE management.
Patients and methods: From March 2019 to March 2023, 73 patients with MPE were prospectively evaluated (54 chest tube pleurodesis, 19 thoracoscopy). The chest tube group underwent bedside drainage followed by povidone-iodine instillation, while the thoracoscopy group had drainage, mechanical pleurodesis, and povidone-iodine application under direct vision. Outcomes included hospital stay, chest tube duration, pain scores (VAS), analgesia requirements, recurrence rates, and patient satisfaction.
Results: Thoracoscopy demonstrated superior outcomes, with shorter chest tube duration (4.84 vs. 5.78 days, p=0.002) and hospitalization (5.32 vs. 6.13 days, p=0.014). Pain control was significantly better in the thoracoscopy group, evidenced by lower mean pain scores (4.42 vs. 5.83, p<0.001) and fewer patients requiring escalated analgesia (15.8% vs. 75.9%, p<0.001). Patient satisfaction scores favored thoracoscopy (6.16 vs. 5.24, p=0.026). Complication (10.5% vs. 3.7%, p=0.284) and recurrence rates (10.5% vs. 13.0%, p=1.000) were comparable.
Conclusion: Thoracoscopic pleurodesis offers distinct advantages over bedside chest tube pleurodesis, including faster recovery, improved pain control, and higher patient satisfaction, without compromising safety or efficacy. These findings support thoracoscopy as the preferred approach for eligible patients, though institutional resources and patient factors must be considered.

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