ABSTRACT Objective: Talc pleurodesis is a widely used treatment option for malignant pleural effusion (MPE). However, the optimal form of administration remains controversial. Thus, we performed a systematic review and meta-analysis to assess the effectiveness of talc slurry (TS) in comparison with thoracoscopic talc insufflation/poudrage (TTI) for MPE treatment. Methods: We searched PubMed, EMBASE, and Cochrane Library databases for studies that compared TS with TTI in patients with MPE. We used a random-effects model with a 95% CI to pool the data. Heterogeneity was assessed with I2 statistics. Results: We included eight studies involving 1,163 patients, 584 of whom (50.21%) underwent TS. Pleurodesis failure rates were similar between the procedures (OR = 1.07; 95% CI: 0.56-2.06; p = 0.83; I2 = 62%); and 68% of patients (95% CI: 0.31-1.47; p = 0.33; I2 = 58%) had postoperative complications, which were lower in patients in the TS group than in the TTI group. In a subgroup analysis considering only randomized clinical trials, the failure rate was significantly lower in the TS treatment group (OR = 0.62; 95% CI: 0.42-0.90; p = 0.01; I2 = 0%). Similarly, dyspnea was less common in the TS group (OR = 0.74; 95% CI: 0.41-1.34; p = 0.32; I2 = 55%). Adverse effects were reported in 86 patients, and no significant difference was seen between the TS and TTI groups: empyema (OR = 1.43; 95% CI: 0.36-5.64; p = 0.86; I2 = 0%), pain (OR = 1.22 (95% CI: 0.67-2.21; p = 0.51; I2 = 38%), and pneumonia (OR = 1.15; 95% CI: 0.30-4.46; p = 0.86; I2 = 27%). Conclusions: Our findings suggest that TS is an effective treatment for MPE, with no significant increase in adverse events. Results suggest equivalent efficacy and safety for both procedures. Objective . (MPE) However controversial Thus metaanalysis meta (TS insufflationpoudrage insufflation poudrage (TTI Methods PubMed EMBASE randomeffects random 95 data I statistics 1163 1 163 1,16 58 50.21% 5021 50 21 (50.21% OR 1.07 107 07 0.562.06 056206 0.56 2.06 0 56 2 06 0.56-2.06 0.83 083 83 62% 62 62%) 68 (95 0.311.47 031147 0.31 1.47 31 47 0.31-1.47 0.33 033 33 58% complications trials 0.62 062 0.420.90 042090 0.42 0.90 42 90 0.42-0.90 0.01 001 01 0%. 0% 0%) Similarly 0.74 074 74 0.411.34 041134 0.41 1.34 41 34 0.41-1.34 0.32 032 32 55%. 55 55% 55%) 8 groups 1.43 143 43 0.365.64 036564 0.36 5.64 36 5 64 0.36-5.64 0.86 086 0%, , 122 22 1.2 0.672.21 067221 0.67 2.21 67 0.67-2.21 0.51 051 51 38%, 38 38% 38%) 1.15 115 15 0.304.46 030446 0.30 4.46 30 4 46 0.30-4.46 27%. 27 27% 27%) Conclusions events (MPE 9 116 16 1,1 50.21 502 (50.21 1.0 10 562 0.562.0 05620 056 0.5 206 2.0 0.56-2.0 0.8 08 6 (9 311 0.311.4 03114 031 0.3 147 1.4 3 0.31-1.4 03 0.6 420 0.420.9 04209 042 0.4 090 0.9 0.42-0.9 0.0 00 0.7 7 411 0.411.3 04113 041 134 1.3 0.41-1.3 14 365 0.365.6 03656 036 564 5.6 0.36-5.6 12 1. 672 0.672.2 06722 067 221 2.2 0.67-2.2 05 1.1 11 304 0.304.4 03044 030 446 4.4 0.30-4.4 1, 50.2 (50.2 0.562. 0562 0. 20 2. 0.56-2. ( 0.311. 0311 0.31-1. 0.420. 0420 04 09 0.42-0. 0.411. 0411 13 0.41-1. 0.365. 0365 5. 0.36-5. 0.672. 0672 0.67-2. 0.304. 0304 44 4. 0.30-4. 50. (50. 0.562 0.56-2 0.311 0.31-1 0.420 0.42-0 0.411 0.41-1 0.365 0.36-5 0.672 0.67-2 0.304 0.30-4 (50 0.56- 0.31- 0.42- 0.41- 0.36- 0.67- 0.30- (5