A META-ANALYSIS ON INDWELLING PLEURAL CATHETERS VS PLEURODESIS IN THE MANAGEMENT OF MALIGNANT PLEURAL EFFUSIONS: A MODERN DILEMMA

Abstract

SESSION TITLE: Palliative Care and End-of-Life Issues SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: The choice between pleurodesis and indwelling pleural catheters (IPC) for the management of malignant pleural effusions (MPE) has been a significant controversial topic because not one of the two interventions has conclusively shown to be superior to each other. Pleurodesis was widely accepted as the treatment of choice for recurrent malignant pleural effusions (MPE). But, it still showed suboptimal results in terms of success rates, re-interventions, side effects, and complications. Recently, studies have shown that IPC can also be done even to patients who fit the criteria for pleurodesis. The paradigm shift revolutionized the goal of treating recurrent MPEs from treating the patient by radiologic evidence of pleural effusion to patient symptoms and quality of life. METHODS: We conducted an extensive search for published studies that compare pleurodesis with indwelling pleural catheters for malignant pleural effusions. Eligibility and bias assessments were done. The primary outcome was the control of effusion. The secondary outcomes were length of hospital stay, dyspnea, quality of life, chest pain and complication rates. RESULTS: Twenty four studies were initially screened until December 2017. However, only four studies with a total of 472 patients met the inclusion criteria. The studies were then analyzed and the results were as follows: A homogenous population (I2 = 14, P = 0.28) who underwent indwelling pleural catheter insertion had significantly decreased length of hospital stay by 3.63 days (95% CI -4.15, -3.16) compared to those who underwent pleurodesis. IPC also showed less loculations or effusions by 45% (CI 95%, 0.23, 1.31) that lead to reintervention by 40% (95% CI -1.78, 0.59), and better survival but it did not establish clinical significance. Pleurodesis, although not statistiscally significant, showed a trend towards better quality of life with a mean difference of 2.02 (CI 95% -5.41, 9.45). It also had reduced complication rates with a RR of 1.61 (CI 95% 0.85, 3.05), empyema of 2% (versus 5% in patients who had pleurodesis) and chest pain with a RR of 1.57 (95% CI 0.53, 4.66). CONCLUSIONS: Compared to pleurodesis, IPC significantly decreased the length of hospital stay and showed a trend towards less recurrence and improved survival. Pleurodesis had a trend towards favorable results in terms of quality of life, complication rates, empyema and chest pain. CLINICAL IMPLICATIONS: This is the first meta-analysis regarding indwelling pleural catheterization versus pleurodesis. Randomized controlled trials are very recent since the controversy of managing recurrent malignant pleural effusion was just brought to the health professionals' attention recently. Thus, the said meta-analysis brings new insight to the dilemma, urge researchers to investigate the findings for stronger validation, and most of all to give the patients the right intervention. DISCLOSURES: no disclosure on file for Ruth Marie Divinagracia; No relevant relationships by ANJULI MAY JAEN, source=Web Response No relevant relationships by Irene Rosellen Tan, source=Web Response no disclosure on file for Ralph Elvi Villalobos