The Impact of Video-assisted Thoracoscopic Versus Percutaneous Tunneled Pleural Catheter Techniques on Pleurodesis Outcomes: A Retrospective, Single-center Study.

Background: Tunneled pleural catheters (TPCs) generate an inflammatory reaction, which, along with frequent drainage, aids in achieving pleurodesis enabling removal in 30% to 50% of patients. However, it is unknown whether the technique of TPC placement influences pleurodesis outcomes.

Methods: This is a retrospective, single-center study of patients who underwent TPC placement from 2010 through 2018. Pleurodesis success was defined as TPC removal within 90 days of placement in the setting of no further drainage and in the absence of catheter malfunction, infection, patient's choice for another treatment modality, or other catheter-related complications. Pleurodesis failure was defined as patients who did not have TPC removal within 90 days of insertion.

Results: A total of 326 patients underwent TPC insertion by thoracic surgery, interventional pulmonology, or interventional radiology. Fourteen patients were excluded due to insufficient follow-up. Of the 312 patients included in the final analysis, 32.7% achieved pleurodesis. Patients who had their TPC inserted thoracoscopically achieved higher pleurodesis success compared with a percutaneous technique (61.2% vs 24.9%, P < 0.001). Thoracoscopically placed catheters had two times greater chance of removal than those inserted percutaneously (hazard ratio: 2.04, 95% CI: 1.14-3.64, P = 0.02) after controlling for pleural biopsies and sclerosing agents used during thoracoscopy.

Conclusions: Thoracoscopic TPC placements may be associated with higher pleurodesis rates compared with a percutaneous technique. Our results are only hypothesis-generating, and these findings warrant confirmation in prospective studies.