Quality of life and outcomes after nonintubated versus intubated video-thoracoscopic pleurodesis for malignant pleural effusion: comparison by a case-matched study.

Abstract

Malignant pleural effusion can be treated successfully by video-assisted thoracic surgery (VATS) talc pleurodesis. This procedure can also be performed using local anesthesia on nonintubated patients. To evaluate quality of life and major outcomes after VATS talc pleurodesis performed under local anesthesia in nonintubated patients with malignant pleural effusion. Retrospective, nonrandomized case-matched comparison (nonintubated versus intubated) pairing the patients by computer according to their clinical features. Since 2002, 231 consecutive patients underwent uniport VATS talc pleurodesis under local anesthesia (nonintubated group). These patients were case matched with 231 homogeneous subjects, selected from a larger group that preferred general anesthesia (intubated group) in the same period. Quality of life (European Organization for Research and Treatment of Cancer QLQ-C30 core questionnaire) and other major outcomes were considered. Pleurodesis was successful in 198 (85.7%) nonintubated and 193 (83.5%) intubated patients, but the former group showed shorter total operating room time (65.8±7.5 versus 84.9±13.3 minutes, p<0.0001), duration of postoperative pleural fluid leakage (2.5±1.0 versus 4.0±1.5 days, p=0.014), postoperative hospital stay (3.1±2.5 versus 4.9±2.8 days, p=0.011), as well as lower perioperative mortality (0% versus 2.3%, p=0.017), morbidity (5.2% versus 9.0%, p=0.042), and costs (6,090±517 versus 9,660±713€, p=0.015). Quality of life presented a similar evolution between groups, however, the early postoperative improvement in physical function (p<0.05), global health (p<0.05), and dyspnea (p<0.01) was significantly greater in nonintubated patients. Significant improvements in respiratory exchanges, postoperative acute stress markers, and mental confusion were also documented. Effusion-free (p=0.35) and overall (p=0.52) survival was similar between groups. Nonintubated VATS talc pleurodesis can achieve similar results in pleural effusion to the same operation performed under general anesthesia but with earlier improvement of some quality-of-life domains as well as better mortality, morbidity, hospital stay, and costs.