BACKGROUND AND AIM: Malignant pleural effusion (MPE) is a common complication of advanced cancer. Both large-bore chest tubes (≥20 Fr) and small-bore catheters (≤14 Fr) are used for drainage and pleurodesis; however, their effects on patient comfort and clinical outcomes remain unclear. This study compared comfort, efficacy, pleurodesis success, and complication rates between these methods.

METHODS: This prospective comparative study enrolled 146 patients with malignant pleural effusion who underwent physician-directed allocation to receive either a large-bore (n=73) or small-bore (n=73) intercostal catheter (ICC) under local anesthesia, followed by talc pleurodesis after lung re-expansion. Outcomes included procedure duration, pain scores, drainage parameters, pleurodesis success, complications, and four-week follow-up.

RESULTS: Baseline characteristics were comparable between groups. Large-bore tubes required a longer insertion time (23.6±2.6 vs. 11.0±1.8 min, p<0.001) and were associated with higher pain scores immediately post-insertion (6.9±1.4 vs. 4.9±1.3, p<0.001), at 6 hours (5.1±1.3 vs. 3.7±1.1, p<0.001), and at 24 hours (3.3±1.2 vs. 2.4±1.0, p<0.001). Drainage volume was higher (1594±340 vs. 1331±415 mL, p<0.001), and time to complete drainage was shorter (34.9±8.8 vs. 39.5±10.5 h, p=0.005) in the large-bore group. Pleurodesis success was comparable (71.2% vs. 68.5%, p=0.686), as was drainage efficacy (80.8% vs. 76.7%, p=0.544). Blockage occurred more frequently in small-bore catheters (5.5% vs. 1.4%, p=0.366), whereas infection (6.8% vs. 1.4%, p=0.209) and dislodgement (5.5% vs. 2.7%, p=0.681) were more common with large-bore tubes.

CONCLUSIONS: Both large- and small-bore chest tubes were effective for pleurodesis in malignant pleural effusion. Large-bore tubes enabled faster and higher-volume drainage but were associated with greater pain and longer procedure times, whereas small-bore tubes provided better patient comfort with comparable efficacy. Small-bore tubes are preferable in most cases, while large-bore tubes may be suitable when rapid, high-volume drainage is required.