Management of Recurrent Malignant Pleural Effusions with Tunneled Pleural Catheters

Indications and Recommendations

The American Thoracic Society recommends tunneled pleural catheters (TPCs) for patients with symptomatic recurrent malignant pleural effusions (MPEs) with documented re-expandable lung, as an alternative to chemical pleurodesis (Grade 1C) 1, 3
TPCs are the recommended first-line treatment for symptomatic recurrent MPE with lung trapping for symptomatic relief and improvement in quality of life (Grade 1C) 1, 4
The British Thoracic Society suggests TPCs are particularly beneficial when length of hospitalization needs to be minimized, such as in patients with reduced life expectancy 5, 6

TPCs result in significantly shorter hospitalization compared to talc pleurodesis (1 day vs 6 days) 5, 6
The use of TPCs leads to a lower rate of subsequent pleural procedures needed (14% vs 32% with talc slurry) 2, 4
Approximately 95% of patients with malignant effusion describe symptomatic benefit from TPCs 3, 4

Spontaneous pleurodesis occurs in approximately 42-46% of patients with TPCs 5, 2
The late failure rate (reaccumulation after initial control) is lower with TPCs (13%) compared to doxycycline pleurodesis (21%) 5, 6

Overall complication rates are approximately 14% 5, 6
The most common complications include local cellulitis (3.4%), empyema (2.8%), catheter removal due to complications (8.5%), tumor seeding along catheter tract (rare, 0.8%), and pneumothorax requiring chest tube (5.9%) 2, 3

Patients with pleural infection, multiple pleural loculations, or inability to manage the catheter at home may not be suitable candidates for TPCs 5, 6
In patients with non-expanding lungs, nearly 50% report being very or moderately satisfied with symptomatic relief from TPC 2, 4