Use of Small-Bore vs Large-Bore Chest Tubes for Treatment of Malignant Pleural Effusions

To evaluate the efficacy of small-bore(12 French van Sonnenberg) catheters compared with standard large-borechest tubes in the drainage and sclerotherapy of malignant pleuraleffusions. Retrospective review. An academic tertiary care hospital. Adult patients with documented neoplasms andmalignant pleural effusions, treated between 1986 and 1995. All patients included in the study underwentdrainage of malignant pleural effusions either by large-bore chest tubeor by ultrasound-guided small-bore catheter. After drainage, pleurodesis was performed. Outcome as definedby recurrence of effusion was determined by blinded examination of allpostpleurodesis chest radiographs. We identified 58 cases of malignantpleural effusion in which small-bore catheters were used and 44 inwhich large-bore chest tubes were used. The majority of patients hadbreast (n = 56, 55%) or lung cancer (n = 29, 28%). The median agewas 65 years. Fifty-nine patients were actively being treated withchemotherapy at the time of pleurodesis. The following sclerosingagents were used: talc, 27 (26%); tetracycline, 72 (70%); bleomycin,2 (2%); and interferon, 1 (1%). Actuarial probabilities of recurrenceat 6 weeks and 4 months were 45% and 53% for the small tubes vs 45%and 51% for the large tubes. Univariate and multivariate analysesfailed to demonstrate that tube size had any influence on the rate ofrecurrence. We were unable to detect anymajor differences in outcomes with the use of either size of chesttube. Our study suggests that small-bore catheters may be effective inthe treatment of malignant pleural effusions and deserve furtherevaluation in prospectively designed trials.