Pleurodesis is a technique used to manage and prevent pleural fluid buildup in the chest cavity. It is an invasive surgical procedure that helps treat malignant pleural mesothelioma. 

A common result of mesothelioma is fluid buildup between the layers of the pleural lining surrounding the lungs. This buildup, known as pleural effusion, often results in pain and breathing difficulties. While it is considered normal to have some fluid present in the pleural space, an excess amount requires removal with pleurodesis or another technique to relieve symptoms and avoid complications. 

Facts About Pleurodesis

  • Pleurodesis aims to remove excess fluid buildup in the pleural space, taking pressure off the lungs.
  • If successful, pleurodesis can also prevent future fluid buildup. 
  • It can alleviate chest pain and shortness of breath associated with malignant pleural mesothelioma.
  • Pleurodesis is less invasive and aggressive than surgical removal of the cancerous pleural tissue.

The primary goal of pleurodesis is to drain off the excess fluid and eliminate the pleural space, reducing the area in which fluid could develop in the future. Pleurodesis is a procedure with palliative benefits. It improves an individual’s quality of life by reducing their pain and discomfort, rather than attempting to cure the disease. By draining a pleural effusion, the pressure on the lungs and chest is significantly reduced, alleviating chest pain and shortness of breath. In turn, more room is available for lung expansion, which helps improve stamina. 

Pleurodesis vs. Other Treatments for Pleural Effusion

One distinction between pleurodesis and other procedures commonly used to treat pleural effusion is that its results are often more permanent. A thoracentesis can remove the excess fluid but does not eliminate the pleural space where more fluid could build up in the future. Similarly, an indwelling pleural catheter can be inserted into the pleural space, allowing for continuous drainage of future pleural effusions. However, this treatment involves constant home care and intermittent experiences of discomfort for the remainder of the recipient’s life.

Who Qualifies for Pleurodesis?

Not all individuals with malignant pleural mesothelioma are candidates for pleurodesis. Pleurodesis is ineffective at sealing the pleural space if the patient’s cancer has advanced so much that the lung is “trapped.” A lung is trapped when it is surrounded by extensive tumor growth on both the inner and outer pleural linings. Patients with a prognosis of a few months are also unlikely to be recommended for the procedure as doctors and medical teams will, in general, attempt to avoid causing the patient any more discomfort. In these circumstances, other palliative treatments may be a more therapeutic alternative. 

A patient in good overall health with localized disease may be recommended for surgical resection of the cancerous pleural linings. Treatments that aim to remove the pleural linings entirely rather than merely sealing the pleural space are considered to be more aggressive. Therefore, the patient’s heart and lung function and disease prognosis must be assessed.

Pleurodesis: Step-by-Step

The first step of pleurodesis is to drain the excess fluid from the pleural space. Then, the two layers of the lining of the pleural space are irritated, creating inflammation and scarring. When scar tissue forms over the irritated area, the two layers fuse, removing the space between them and preventing future fluid buildup.

There are two methods of performing pleurodesis. The most common of the two chemically induces pleural inflammation and scarring. It is easier and cheaper to perform than the other method: mechanical pleurodesis.

Chemical Pleurodesis

Chemical pleurodesis is achieved using talc, a clay-based material found in baby powder. Medical grade talc used for procedures like pleurodesis is chemically pure and sterile. Talcum powder is placed onto the pleural linings using thoracoscopic tools or a fluid mixture delivered through a tube. Once the talc has sufficiently covered the area, it is removed via suction. Other chemicals and substances can be used for chemical pleurodesis, such as tetracycline, bleomycin, povidone-iodine, and nitrogen mustard. These substances are often more expensive and less effective than talc, which is why talc is more commonly used instead.1

Rapid Pleurodesis

The primary drawback of talc-assisted chemical pleurodesis is the prolonged hospital stay required to recover from the surgery. This recovery typically takes up to a week, explaining why many surgical oncologists opt to install a pleural catheter instead. 

Rapid pleurodesis combines chemical pleurodesis with the installation of a pleural catheter. Successful rapid pleurodesis allows the patient to be discharged from the hospital within 48 hours. Rapid pleurodesis can be as effective as traditional chemical pleurodesis, and with a shorter hospital stay to boot. 

Mechanical Pleurodesis

By sealing or fusing the pleura layers, doctors can prevent future buildup of pleural effusions and improve the quality of a patient’s breathing. This fusing, caused by irritation, is traditionally caused using talc in chemical pleurodesis, but the same effect can be generated using mechanical implements, such as gauze, rough pads, rotary brush, etc. This method is more invasive than its chemical counterpart, but it may provide better symptom relief than chemical pleurodesis for some individuals.2

Risks and Potential Complications of Pleurodesis 

As with all medical procedures, pleurodesis has risks and potential complications. It is important to know what they are.

The most common adverse events are

  • Fever
  • Chest pain
  • Gastrointestinal symptoms

Less common adverse events include

  • Shortness of breath
  • Systemic inflammatory reaction: signs and symptoms of inflammation
  • Arrhythmia: heart rhythm abnormalities
  • Subcutaneous emphysema: trapping of air beneath the skin
  • Persistent air leak: failure to reinflate the lung despite chest tube drainage
  • Deep vein thrombosis: blood clot formation in a deep vein, typically of the thigh or leg
  • Empyema: infection within the chest cavity
  • Pneumonia: infection of the lung
  • Respiratory failure
  • Blood transfusion

The pain may feel like a burning sensation or tightness across the chest. It is treated with pain medication. Fever is a natural component of the body’s inflammatory response to the procedure. It most commonly develops within 4 to 12 hours after the procedure. Infections may arise within the chest cavity or the lung. Such infections are prevented and treated with antibiotics. Routine monitoring and management of other risks and potential complications help to ensure safe and effective treatment with pleurodesis.