A pleurodesis is a surgical procedure used to treat and prevent pleural effusions, a major symptom of pleural mesothelioma and other asbestos-related diseases. If a patient is not eligible for tumor-removing surgery, a pleurodesis can still improve their quality of life by relieving pain and making it easier to breathe.
Written by Karen Selby, RN Edited By Walter Pacheco Medically Reviewed By Dr. Chuong Hoang
Asbestos.com is the nation’s most trusted mesothelioma resource
The Mesothelioma Center at Asbestos.com has provided patients and their loved ones the most updated and reliable information on mesothelioma and asbestos exposure since 2006.
Our team of Patient Advocates includes a medical doctor, a registered nurse, health services administrators, veterans, VA-accredited Claims Agents, an oncology patient navigator and hospice care expert. Their combined expertise means we help any mesothelioma patient or loved one through every step of their cancer journey.
More than 30 contributors, including mesothelioma doctors, survivors, health care professionals and other experts, have peer-reviewed our website and written unique research-driven articles to ensure you get the highest-quality medical and health information.
About The Mesothelioma Center at Asbestos.com
- Assisting mesothelioma patients and their loved ones since 2006.
- Helps more than 50% of mesothelioma patients diagnosed annually in the U.S.
- A+ rating from the Better Business Bureau.
- 5-star reviewed mesothelioma and support organization.
"My family has only the highest compliment for the assistance and support that we received from The Mesothelioma Center. This is a staff of compassionate and knowledgeable individuals who respect what your family is experiencing and who go the extra mile to make an unfortunate diagnosis less stressful. Information and assistance were provided by The Mesothelioma Center at no cost to our family."LashawnMesothelioma patient’s daughter
How to Cite Asbestos.com’s Article
Selby, K. (2023, March 23). Pleurodesis. Asbestos.com. Retrieved March 31, 2023, from https://www.asbestos.com/treatment/surgery/pleurodesis/
Selby, Karen. "Pleurodesis." Asbestos.com, 23 Mar 2023, https://www.asbestos.com/treatment/surgery/pleurodesis/.
Selby, Karen. "Pleurodesis." Asbestos.com. Last modified March 23, 2023. https://www.asbestos.com/treatment/surgery/pleurodesis/.
What Is a Pleurodesis?
Pleurodesis is a procedure to eliminate the pleural space so fluid can no longer accumulate there. Pleurodesis is a type of palliative treatment for pleural mesothelioma and many other cancers, meaning doctors perform it to relieve symptoms rather than kill or remove cancer cells.
- Prevents future fluid buildup in most patients
- Alleviates several pleural mesothelioma symptoms
- Less invasive than major tumor-removing surgery
The coughing, chest pain and breathing difficulty associated with asbestos-related diseases are often caused by a buildup of excess fluid in the space between the inner and outer layers formed by the pleural lining around the lungs. This condition is called a pleural effusion, and it makes breathing difficult because it puts pressure on the lungs. If left untreated, it may lead to infection or the collapse of a lung.
Pleurodesis offers a more permanent solution than the other common procedures for treating pleural effusions. A thoracentesis procedure drains excess fluid but does not seal the pleural space, while the insertion of a pleural catheter requires regular home maintenance, potentially for the rest of a patient’s life.
Who Qualifies for a Pleurodesis?
Not all pleural mesothelioma patients are candidates for a pleurodesis.
If the cancer has progressed to an advanced stage and the patient has a trapped lung, meaning there is extensive tumor coverage of the pleural lining such that the lung cannot fully expand, a pleurodesis will not be effective at sealing the pleural space, according to a 2017 review of the procedure.
In addition, patients with a life expectancy of a few months may not undergo the procedure because they may want to avoid hospital stays and the discomfort associated with recovering from surgery. In these cases, doctors will consider other palliative treatments for mesothelioma.
On the other hand, if the patient is in good overall health and the cancer is still localized, they may be a candidate for a more aggressive tumor-removing surgery such as pleurectomy/decortication. Aggressive treatment of pleural mesothelioma usually involves removing the pleural lining rather than sealing it.
Surgical Consultation for Pleurodesis
A surgical consultation is an important step to determine whether a patient is a good fit for a pleurodesis. During a consultation, patients meet with the surgeon and surgical team to discuss eligibility, risks, benefits and the potential for complications. The surgical team will review all medical records, including personal history and all records related to the mesothelioma diagnosis.
Consultations may be carried out in person or virtually through video conferencing. Patients may ask questions about the procedure, bring up any concerns or fears they may have and get to know more about the surgeon and the surgical team.
A pleurodesis procedure typically involves a hospital stay of three to seven days, though a newer method being tried by some specialists requires only a brief overnight stay. Before the procedure, patients are usually medicated with a narcotic for pain and a benzodiazepine, such as Xanax, for comfort.
Before the actual pleurodesis procedure, excess fluid from the pleural space needs to be drained. The next step is to irritate the two layers of the pleural lining, which provokes inflammation and scarring. The scar tissue fuses the two pleural layers together, eliminating the space between them.
There are two common methods for producing inflammation in the pleural lining: chemical and mechanical. Because of its low cost and the ease of the procedure, the most common method is chemical pleurodesis with talc.
Talc is a type of clay mineral, and it has historically been the main ingredient in baby powder. The talc used for pleurodesis is medical grade, sterile and asbestos-free.
During chemical pleurodesis, talcum powder can be inserted into the pleura using thoracoscopy tools, or it can be mixed with fluid into a talc slurry and inserted through a chest tube. In either approach, a chest tube is left inserted until talc is sufficiently distributed and then removed.
Substances such as bleomycin, tetracycline, nitrogen mustard and povidone iodine can also be used for chemical pleurodesis, but talc is the most popular option because it is effective and the least expensive to administer.
A 2013 Australian review of pleurodesis for mesothelioma patients confirmed talc pleurodesis as the most effective treatment, and a 2016 Cochrane review also found talc pleurodesis the most effective for malignant pleural effusions.
In a 2021 retrospective study, chemical pleurodesis was successful in over 31% of cases and had a significant contribution to patient survival.
“Attitude counts for a lot, and willingness to pursue the treatment recommendations all add up to a better chance for survival.”Jo D.Talc pleurodesis patient and pleural mesothelioma survivor diagnosed in 2009
One disadvantage of the talc pleurodesis procedure is the hospital stay often required for recovery. Many specialists recommend inserting a pleural catheter instead because it can be done as an outpatient procedure.
To find the best compromise between these two options, specialists have developed a “rapid pleurodesis” procedure that uses a pleural catheter and chemical pleurodesis. This method allows most patients to be discharged from the hospital within 48 hours.
A 2014 randomized trial and a 2016 retrospective analysis determined a rapid pleurodesis protocol can be as effective as the common chemical pleurodesis procedure most doctors currently follow.
Another way to cause the layers of the pleura to fuse together is to irritate them with a rough pad, gauze or a mechanical rotary brush instead of inserting a chemical substance.
Though this method may involve a more invasive surgical procedure, the results of a 2015 study suggest mechanical pleurodesis may provide greater symptom relief than chemical pleurodesis.
Pleurodesis Complications and Side Effects
Chest pain and fever are the most common adverse effects of pleurodesis. Some patients report a tight or burning feeling around the lungs, but this is usually eased with medication prior to the procedure. Because of the inflammatory response that helps seal the pleural space, a fever can develop about four to 12 hours after a talc pleurodesis.
Common side effects and complications of pleurodesis:
- Chest pain
As with any surgical procedure, there is a risk of infection that may need to be treated with antibiotics. In rare cases, pleurodesis may result in cardiovascular complications or acute respiratory distress syndrome.