Pleurodesis

What Is Pleurodesis?

Pleurodesis is a surgical procedure used to treat pleural effusions, the buildup of fluid in the space between the layers of the pleura. For people with pleural mesothelioma, this fluid buildup can make breathing difficult and painful. The procedure seals the pleura so that the lung sticks to the chest wall, preventing more fluid from collecting.

Pleurodesis: Key Facts

• Pleurodesis is a medical procedure that permanently seals the pleural space, the area between the lung and chest wall, to prevent fluid or air from accumulating.
• Doctors most commonly perform pleurodesis to treat recurrent pleural effusions, a buildup of excess fluid that causes shortness of breath, chest pressure and pain.
• The 2 main types are chemical pleurodesis, which uses agents like talc to create scar tissue, and mechanical pleurodesis, which uses physical abrasion during surgery.
• According to clinical research, talc pleurodesis has a success rate of approximately 80% to 95% in preventing fluid recurrence (National Library of Medicine).
• Most patients stay in the hospital for approximately 3 to 5 days after pleurodesis, with full recovery typically taking several weeks.

Doctors don’t use pleurodesis to treat your mesothelioma directly. Instead, it controls one of the most disruptive symptoms of asbestos-related diseases: pleural effusion. According to a 2024 study in Open Respiratory Archives, about 30% of mesothelioma patients receive pleurodesis.

As Sean Marchese, R.N., an oncology writer for The Mesothelioma Center, explains, “Pleurodesis for mesothelioma closes and seals the pleural space in the chest wall where fluid can build up. This technique reduces your risk of pleural effusions, pneumonia and other chest complications.”

Types of Pleurodesis Procedures

There are two main types of pleurodesis for mesothelioma patients: chemical and mechanical. Studies have shown similar results between mechanical and chemical pleurodesis. No matter the type, the procedure usually requires about 3 to 5 days in the hospital.

Doctors choose which type of pleurodesis to perform based on a patient’s overall health, cancer stage and treatment goals. Doctors often choose chemical pleurodesis for patients who can’t have surgery, while surgeons typically perform mechanical pleurodesis during another surgical procedure.

Chemical Pleurodesis

Doctors use agents such as talc (a mineral), tetracycline (an antibiotic) and povidone-iodine (an antiseptic) in chemical pleurodesis for mesothelioma. These ingredients help create the scar tissue needed.

There are 2 main ways to do pleurodesis with talc: poudrage and slurry. Poudrage sprays talc powder into the chest during a small camera procedure called thoracoscopy. Slurry mixes talc with saline and is inserted through a chest tube.

A faster method is rapid pleurodesis, which drains the fluid and delivers the treatment at the same time. It helps you recover quicker and leave the hospital sooner, especially if you’re not healthy enough for surgery.

According to the National Library of Medicine, talc pleurodesis has a success rate of approximately 80% to 95% in preventing the recurrence of pleural effusions. This makes talc the most widely used and effective sclerosing agent, which is a substance used to deliberately cause irritation so inflammation will happen and seal the space. The success rate depends on factors including the patient’s overall health, how well the lung can expand and the volume of fluid present before the procedure.

Mechanical Pleurodesis

Mechanical pleurodesis for mesothelioma is a procedure that uses tools such as gauze or a brush pad to irritate the chest lining. This process causes inflammation and the formation of scar tissue, which creates dry adhesion, making the lung stick to the chest wall. 

Surgeons usually do this procedure during a small camera surgery called video-assisted thoracoscopic surgery. Sometimes, VATS is done during a larger surgery called a thoracotomy after removing fluid or air. In some cases, part or all of the lining of the lung (pleura) is removed. 

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What to Expect From a Pleurodesis Procedure 

How long your pleurodesis procedure will take depends on the type being performed and the amount of fluid that needs to be drained. Usually pleurodesis takes anywhere from 30 minutes to several hours. Chemical pleurodesis, including rapid pleurodesis, usually takes less time than mechanical pleurodesis.

What to Expect During Pleurodesis

1. Fluid drainage: First, your doctor inserts a small tube into your chest to remove fluid. This helps your lungs expand. The tube stays for 1 or 2 days until the fluid stops.
2. Sealing the pleura: After draining fluid, your doctor may add talc or perform a minor procedure to help the lung layers stick together, causing controlled irritation that forms an adhesion. You might feel chest pain, which will be treated with medication.
3. Hospital stay & recovery: You’ll stay in the hospital for a few days for observation and to manage pain. The tube is taken out once the pleura is sealed. Full recovery can take a few weeks. Your doctor will give you care instructions for home.

Recovery begins in the hospital, but most people go home after 3 to 5 days. Complete recovery may take a few weeks. Your mesothelioma care team or a Patient Advocate can help answer any further questions you may have about the procedure. 

Recovery From Pleurodesis Surgery

Recovering from mesothelioma surgery like pleurodesis involves a short hospital stay and then several weeks of rest at home. During recovery, you may have restrictions on lifting or driving and should avoid strenuous activity. Your care team will manage your pain and ensure your lung remains sealed to the chest wall.

You can eat bland foods if your stomach is upset after anesthesia. Your medical team will tell you how long to leave dressings, tape or stitches on. Avoid swimming or baths for 2 weeks. Showering is okay after 2 days, but pat the incision dry.

Who Qualifies for a Pleurodesis?

If you’ve been diagnosed with malignant mesothelioma, you may qualify for pleurodesis if pleural effusions impact your daily life and you can tolerate the procedure. For pleurodesis to work well, your lung needs to expand fully. People whose tumors are so large that their lung can’t fully expand aren’t good candidates for this procedure.

Who May Qualify for Pleurodesis

• Patients with fluid in chest that often builds up, needing to be drained once or more each month.
• Your expected life expectancy should be at least 3 months.
• You should be able to tolerate general anesthesia and long surgeries.
• You should be generally healthy.

People with localized cancer who are in good health may also choose a more aggressive treatment, such as pleurectomy/decortication, to remove the tumor. This surgery removes the pleural lining rather than just sealing it. Those who don’t want to undergo hospitalization or recovery from pleurodesis may opt for different palliative treatments for mesothelioma.

In addition to treating pleural effusions from mesothelioma, doctors also use pleurodesis to treat fluid buildup from other cancers. They may also use it for pleural effusions from heart failure, kidney or liver problems, autoimmune diseases and long-term lung issues. 

David Doust

Verified Asbestos.com Survivor

Second Pleurodesis Leads to Mesothelioma Diagnosis

Doust’s journey with the asbestos-related cancer began in early 2016 when he experienced shortness of breath, or dyspenea. Wrongly diagnosed with pneumonia, he underwent a pleurodesis to remove excess fluid from around the lungs and was soon back to his exercise routine. Upon returning to Perth, he underwent another pleurodesis. He was told he had acute lymphatic leukemia and pleural mesothelioma.

David Doust

Verified Asbestos.com Survivor

Read David’s Story

Benefits of Pleurodesis for Mesothelioma

Pleurodesis offers several benefits for people living with pleural mesothelioma, such as symptom relief and reduced need for ongoing care. Its main goal is to improve quality of life, relieving symptoms.

Key Benefits of Pleurodesis for Mesothelioma

1. Symptom relief: Helps ease shortness of breath and chest pressure.
2. Reduced recurrence risk: Prevents pleural fluid from returning.
3. Reduced hospitalizations: Fewer fluid drainages and emergency visits.
4. Alternative to ongoing care: May reduce the need for repeated procedures.

Symptom management is an important part of treating pleural mesothelioma. Procedures like pleurodesis help people feel more comfortable as they explore additional treatments that directly address mesothelioma.

I had chest pain when I took a deep breath. I eventually had a biopsy and pleurodesis that provided the definitive diagnosis. Attitude counts for a lot, and willingness to pursue treatment adds up to a better chance for survival.

Jo D. , pleural mesothelioma survivor.

Pleurodesis Complications and Risks

The most common risks of pleurodesis for mesothelioma are chest pain and fever. Some people may feel shortness of breath or tightness around the lungs, but medicines can usually help before the procedure. 

Fever is frequently associated with the inflammatory response that helps seal the pleural space. It may develop within a few hours of the procedure. In some cases, the procedure may not succeed, leading to incomplete adhesion of the pleural wall spaces.

Risks of Pleurodesis for Mesothelioma

• Chest pain
• Fever
• Infection

Any surgical procedure carries a risk of infection. Generally, a medical team can treat infections with antibiotics. In very rare cases, pleurodesis can cause other complications, such as acute respiratory distress syndrome or cardiovascular complications.

One patient was diagnosed with mesothelioma seven years after undergoing a talc pleurodesis procedure, having had no prior mesothelioma diagnosis. Testing traced his diagnosis to the talc used during his procedure, which was found to be contaminated with asbestos. Talc is a naturally occurring mineral often found near asbestos in the earth. Asbestos can contaminate talc during mining. The patient filed a lawsuit and a jury awarded him $39 million, which a judge later reduced to $23.6 million. If you have concerns about the use of talc in your procedure, speak with your doctor about your options.

Common Questions About Pleurodesis

What is the life expectancy for mesothelioma patients after a pleurodesis?

Life expectancy after a pleurodesis depends on other treatments and health factors. Many patients live for several months to a year or more after pleurodesis, especially when combined with other therapies.

What are the long-term effects of pleurodesis?

The most common long-term effects include mild chest discomfort or occasional shortness of breath. In most cases, pleurodesis successfully prevents fluid buildup without major complications.

Why is pleurodesis used for pleural mesothelioma?

Pleurodesis treats pleural effusions, a common and painful symptom of pleural mesothelioma. It helps reduce shortness of breath and improves comfort.

Is pleurodesis a cure for mesothelioma?

No, pleurodesis doesn’t cure mesothelioma. It’s a palliative procedure that helps manage symptoms. At the moment, there is no cure for mesothelioma.

What type of pleurodesis is best for mesothelioma patients?

The best type depends on your health and cancer stage. Chemical pleurodesis is common, especially for people who can’t have surgery. Mechanical pleurodesis is often used during other surgeries.

How long does a pleurodesis procedure take?

The time it takes to complete a pleurodesis ranges from 30 minutes to several hours. Factors that affect how long it could take include the procedure type and the volume of fluid present. Chemical pleurodesis through a chest tube often takes less time than mechanical pleurodesis during video assisted thoracic surgery or VATS. Patients typically stay in the hospital for approximately 3 to 5 days after the procedure for observation and recovery.

What is the success rate of pleurodesis?

Talc pleurodesis, the most commonly used form, has a success rate of approximately 80% to 95% in preventing the recurrence of pleural effusions, according to the National Library of Medicine. Success rates can vary based on the patient’s health, cancer stage and whether the lung can fully expand. Chemical and mechanical pleurodesis generally show similar effectiveness, though individual outcomes depend on the specific clinical situation.

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