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

Study objective: To evaluate the efficacy of small-bore (12 French vanSonne nberg) catheters compared with standard large-bore chest tubes in the drain age and sclerotherapy of malignant pleural effusions, Design: Retrospective review. Setting: An academic tertiary care hospital. Patients: Adult patients with documented neoplasms and malignant pleural ef fusions, treated between 1986 and 1995, Intervention: All patients included in the study underwent drainage of mali gnant pleural effusions either by large-bore chest tube or by ultrasound-gu ided small-bore catheter, After drainage, pleurodesis was performed, Results: Outcome as defined by recurrence of effusion was determined hy bli nded examination of all postpleurodesis chest radiographs, We identified 58 cases of malignant pleural effusion in which small-bore catheters were use d and 44 in which Barge-bore chest tubes were used. The majority of patient s 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 chemotherap y at the time of pleurodesis, The following sclerosing agents were used: ta lc, 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. Univariat e and multivariate analyses failed to demonstrate 1:hat tube size had any i nfluence on the rate of recurrence. Conclusions: We were unable to detect any major differences in outcomes wit h 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.