En Bloc Society:

Hong Kong Thoracic Society (HKTS)

Team members:

Principal Investigator:

Dr CHAN King-Pui Florence (Hong Kong)

Co-Investigators:

Dr LUI Mei-Sze (Hong Kong)
Dr HO, James Chung-Man (Hong Kong)
Dr Lam, David Chi-Leung (Hong Kong)

Project term:

1 February 2026 – 31 January 2027

Project summary

Malignant pleural effusion (MPE) imposes a high burden on the healthcare system in the Asian Pacific region, as lung and breast cancer are the commonest cancers associated with malignant pleural effusion, as the two commonest cancers in the Asian Pacific region. While indwelling pleural catheter (IPC) is not commonly used in Asian countries, small-bore chest tubes are increasingly used due to their ease of insertion and causing less pain. Talc pleurodesis was an effective method of managing MPE. However, the optimal size of small-bore chest tubes and the feasibility of talc pleurodesis have not been thoroughly investigated. In our local territory hospital, the management of MPE, including small-bore chest tubes of 8 French (Fr), 12 Fr, and 14 Fr, followed by talc pleurodesis, was previously reported at the 28^th Congress of the Asian Pacific Society of Respirology and received the education award.

This randomised controlled trial aims to evaluate the feasibility and success rate of pleurodesis using small-bore chest drains and to examine the outcomes associated with different sizes of these drains, namely 8 Fr, 12 Fr, and 14 Fr, in managing MPE. The primary outcome is the feasibility of talc pleurodesis with different small-bore chest tubes. Secondary outcomes include the differences in recurrence rates post-pleurodesis between small-bore and ultra-small-bore chest tubes, as well as patient outcomes such as pain scores, SpO2/FiO2 ratios (oxygen saturation/fractional inspired oxygen ratio), and complications. The sample size will be 60, and the project will be carried out over one year. The outcome of this study can serve as a reference for managing MPE regarding the feasibility, safety, and efficacy of ultra-small-bore chest tubes worldwide, particularly in the Asia-Pacific region, where IPC is less common.