Comment on: TAPPS shows no difference in outcomes by talc delivery method
TAPPS is an important study [1] that finally settles the key question of whether talc pleurodesis should be performed via a thoracoscopic approach (talc poudrage) or via slurry (instillation of talc through a chest tube).
Importantly, this study addressed several of the limitations of a prior randomized controlled trial [2] which suffered from several methodological limitations, used a small-particle talc preparation known to be associated with respiratory complications, and considered a surgical approach rather than medical thoracoscopy under conscious sedation.
In addition, the primary endpoint in this new trial was clinically-relevant pleurodesis failure at 90 days, versus the arguably less meaningful radiologic endpoint at 30 days used in the prior study.
This study demonstrates that talc pleurodesis via thoracoscopy and talc slurry through an existing chest tube are equivalent in patient with expandable lung, arguing for a less invasive approach in this often fragile patient population.