Pleurodesis for Pleural Mesothelioma 

What Is Pleurodesis? 

Pleurodesis is a medical procedure used to treat pleural effusion, a condition where excess fluid builds up in the space between the lungs and chest wall. Buildup is common in individuals with pleural mesothelioma and can cause difficulty breathing and chest pain.  

During the procedure, an irritant (such as talc) is introduced into the pleural space to intentionally cause inflammation. This inflammation fuses the two pleural layers together, eliminating the space where fluid would normally collect. The goal of pleurodesis is to prevent recurrent pleural effusions and improve a patient’s comfort and quality of life. This procedure is often recommended for severe or recurrent pleural effusion associated with medical illnesses like mesothelioma, lung cancer, and asbestosis. By sealing the pleural layers, the procedure helps patients breathe easier and reduces pressure and pain in the chest. 

For those diagnosed with pleural mesothelioma, pleurodesis may offer symptom relief and improve overall well-being. While it is not a cure, many patients experience significant improvement following the procedure. It is important to understand the side effects of pleurodesis, its success rates, and the expected recovery process before deciding if it is right for you or your loved one. 

If you are exploring options like talc pleurodesis or a pleural effusion medical procedure, we encourage you to continue reading to learn more about pleurodesis and whether it could be the right treatment path in your mesothelioma care plan.  

Who Needs a Pleurodesis Procedure? 

Pleurodesis is commonly recommended for patients diagnosed with pleural mesothelioma or malignant pleural effusion (MPE). These conditions often cause recurring fluid buildup, which leads to shortness of breath, chest pain, and other serious symptoms. By eliminating the pleural space, pleurodesis can relieve this discomfort and improve quality of life. 

Patients with lung cancer or cancers that have metastasized into the lungs may also benefit from pleurodesis if they experience symptomatic pleural effusions. When effusion becomes frequent or difficult to manage, pleurodesis is often used to provide lasting relief. However, pleurodesis is not always the best option. It may not be suitable for patients with non-expandable lungs or those with tumors or fibrosis that prevent full lung expansion. In these cases, pleurodesis would not be effective. Common alternative treatments include indwelling pleural catheters (IPCs), pleuroperitoneal shunts, therapeutic thoracentesis, or pleurectomy. 

Pleurodesis Procedure for Pleural Mesothelioma 

Before undergoing pleurodesis for pleural mesothelioma, patients must be thoroughly evaluated to determine if they are suitable candidates. This includes assessing overall health and ensuring the lungs are capable of full re-expansion, a critical factor for the success of the procedure. 

The first step involves completely draining the pleural effusion using a chest tube. After drainage, a chest radiograph should be performed to confirm lung re-expansion. If the lungs remain unexpanded, pleurodesis may fail and lead to complications such as pleural thickening or lung entrapment. In some cases, if chest tube output remains high (over 150 mL per day), the procedure may be delayed. However, pleurodesis can sometimes be performed sooner if the lung has fully re-expanded and there are no visible air leaks.  

Pain management treatment is essential during the procedure. Patients are typically given a parenteral opioid analgesic, such as fentanyl, or a benzodiazepine like midazolam to ensure comfort. If these are not effective or appropriate, NSAIDs may also be considered. Once the patient is comfortable and stable, the sclerosing agent (commonly talc) is reconstituted with sterile saline to the appropriate concentration and volume, then administered through the chest tube. This agent triggers inflammation in the pleural space, causing the layers to adhere and preventing further fluid buildup. 

Types of Pleurodesis Procedures 

There are two primary types of pleurodesis: chemical pleurodesis and mechanical pleurodesis. Both methods are designed to eliminate the pleural space by causing intentional inflammation, which binds the pleural layers together and prevents fluid buildup. 

Chemical pleurodesis is the most common method and involves introducing a sclerosing agent, but sometimes doxycycline or bleomycin, into the pleural cavity. These agents cause inflammation and scarring, which results in the pleura adhering tightly to the lungs. Talc is the most widely used due to its high success rate and effectiveness in managing conditions associated with pleural mesothelioma through a pleural effusion medical procedure.

Mechanical pleurodesis, on the other hand, is typically performed by physically irritating or abrading the pleural lining. This manual disruption also triggers inflammation and scarring, causing the pleural layers to stick together.  

The choice between chemical and mechanical pleurodesis often depends on the patient’s condition, the underlying cause of the effusion, and whether the procedure is being performed during thoracoscopic surgery. In some cases, both techniques may be combined to improve outcomes and prognosis. Moreover, each method has its own risks, side effects, and recovery expectations, which should be carefully discussed with a specialist. 

Chemical Pleurodesis  

As mentioned above, chemical pleurodesis involves introducing a sterile substance, most commonly talc, into the pleural cavity. This agent irritates the pleural lining, triggering inflammation and scar tissue formation that permanently binds the lung to the chest wall. This effectively eliminates the pleural space, preventing the recurrence of pleural effusion or pneumothorax (a collapsed lung), which causes shortness of breath. 

Talc pleurodesis is widely used for patients with pleural mesothelioma and malignant pleural effusions, offering a minimally invasive solution to recurring fluid buildup. In fact, talc pleurodesis has a success rate of approximately 50% to 80%, making it one of the most effective options available for long-term symptom relief.  

While often effective, the procedure does come with potential side effects such as chest pain, discomfort due to inflammation, low-grade fever, or flu-like symptoms within the first 48 hours (about 2 days), and shortness of breath or temporary breathing difficulties. In rare cases, complications may include respiratory failure, low blood pressure, or even severe lung inflammation. Though most patients experience improved lung function following the procedure, some studies have reported mild to moderate restrictive impairment or pleural thickening as a long-term effect. These outcomes are rare and should be weighed against the benefits of controlling effusion and improving breathing comfort. 

Mechanical Pleurodesis 

Mechanical pleurodesis is a procedure in which the pleural lining is physically irritated to trigger inflammation and scarring. This controlled inflammation causes the pleural layers to stick together, effectively eliminating the pleural space and preventing future fluid or air buildup. It is commonly used in treating pleural effusion and pneumothorax, especially in patients with pleural mesothelioma. 

During mechanical pleurodesis, a surgeon uses a brush, pad, or gauze to gently scrape the pleural surfaces. This is typically done during video-assisted thoracoscopic surgery (VATS), which often reduces the number of surgical side effects. Unlike chemical pleurodesis, which uses agents like talc to create inflammation, mechanical pleurodesis relies solely on manual abrasion to achieve the same effect. This method may be preferred in surgical treatment settings when chemical agents are contraindicated. In some cases, mechanical and chemical pleurodesis may be combined for greater effectiveness. 

Success rates for mechanical pleurodesis range from 70% to 95% depending on the patient’s condition and lung re-expansion. While safe, side effects may include chest pain due to inflammation, fever, and short-term breathing problems. Rare but more serious complications may include infection, lung collapse, or acute respiratory distress syndrome (ARDS). 

Mechanical pleurodesis can be an effective solution for patients seeking relief from pleural effusion caused by mesothelioma or other serious illnesses, particularly when chemical methods are not ideal. 

Life Expectancy and Side Effects of Pleurodesis Treatment 

While pleurodesis can offer significant relief from pleural effusion, it is important for patients to understand the potential complications and side effects. Common issues include pain and inflammation at the treatment site, fever, and temporary shortness of breath. Some patients may experience more serious complications such as: 

• Infection 

• Pneumothorax (collapsed lung) 

• Acute respiratory distress syndrome (ARDS) 

• Systemic reactions 

• Procedure failure, which can lead to the recurrence of pleural effusion 

In pleural mesothelioma patients, pleurodesis does not cure the disease, but it is often used to relieve the symptoms of mesothelioma. When successful, the procedure can reduce the need for repeated fluid drainage, promote improved quality of life, and in some cases, contribute to extended life expectancy by minimizing complications associated with recurrent effusions. 

While survival rates for mesothelioma vary widely based on state, cell type, and overall health, studies suggest that patients who undergo pleurodesis often experience better symptom control and require fewer hospitalizations than those who opt for repeated thoracentesis or conservative treatments alone. However, pleurodesis is not always suitable for patients with trapped lungs or poor lung function. 

Next Steps: Finding the Right Treatment Plan 

If you or a loved one is facing pleural mesothelioma and dealing with pleural effusion, our team is here to help. Schedule a free case evaluation to find out if pleurodesis is the right treatment for you. Get expert guidance from specialists who understand your diagnosis and can help you explore your best options.