Therapy

An alternative is surgical pleurodesis using thoracoscopy ^a ,   using talc. ^{b d}

Why?

• Thoracoscopic talc poudrage leads to fewer recurrent effusions than bleomycin pleurodesis. ^a
• There is no clear difference in mortality rates, length of stay in hospital or use of analgesia post-procedure between the two techniques. ^d 
• Talc is the most effective sclerosant but requires thoracoscopy. ^{b d}

Malignant effusions: thoracoscopic talc poudrage prevents recurrent effusions better than bleomycin

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
malignant pleural effusion a	thoracoscopic talc poudrage	bleomycin pleurodesis	recurrent effusion at 6 months	69%	81% (27% to 95%)	2 (1 to 4)