Background: Malignant pleural effusion (MPE) is a common complication in patients with metastatic cancer, resulting in debilitating symptoms and worsening performance status and quality of life. The prevention of recurrent MPE can be achieved with either thoracoscopic talc poudrage (TTP) or indwelling pleural catheter (IPC).

Objective: To access the success rate of combined TTP and IPC, compared with TTP alone, in patients with symptomatic MPE.

Methods: A single-center randomized, non-inferiority trial was conducted in symptomatic MPE. Patients were randomly allocated to either receive TTP and IPC or TTP alone. Primary outcome was success rate of pleurodesis at 12 weeks after the procedure.

Results: Twenty-six patients were randomized, mean age was 61 (61.58±12.34) years old. Twelve patients underwent combined TTP and IPC (TTP+IPC). No statistically significant differences were noted in baseline characteristics, except higher dyspnea score in the TTP+IPC group. 23 patients were complete follow-up at 12 weeks, the pleurodesis success was occurred in 8 of 9 patients (88.89%) in the TTP+IPC group and 9 of 14 patients (64.29%) in the TTP group, with a difference of 24.6%[95%CI, -7.83% to 57.03%]. TTP+IPC spent significantly shorter hospital length of stay after procedure (1.5[1-2] vs 3[3-4], p<0.001), greater reduction of dyspnea and pain, with out increasing procedure related complication.

Conclusion: Among patients with symptomatic MPE, using combination of TTP and IPC was effective and safe with shorter LOS and better quality of life.