Small particle-size talc is associated with poor outcome and increased inflammation in thoracoscopic pleurodesis.

Rationale: Talc is very effective for pleurodesis, but there is concern about complications, especially acute respiratory distress syndrome.

Objectives: It was the aim of this study to investigate if talc with a high concentration of small particles induces greater production of cytokines, and if pleural tumor burden has any influence on the local production and spillover of cytokines to the systemic circulation and eventual complications.

Methods: We investigated 227 consecutive patients with malignant effusion submitted to talc pleurodesis.