Abstract
BackgroundTalc pleurodesis (TP) and indwelling pleural catheter (IPC) are used for the management of malignant pleural effusion (MPE). Our meta-analysis was conducted to assess the efficacy and safety of both treatments among patients with MPE.MethodsWe acquired pertinent randomized controlled trials (RCTs) by searching PubMed, ScienceDirect, the Cochrane Library, Scopus, Ovid Medline, Embase, Web of Science, and Google Scholar. The endpoints included survival, pleurodesis rates, total drainage, further pleural interventions, hospital days, symptoms, quality of life (QoL), and complications.ResultsWe included four high-quality RCTs. Both treatments were effective among patients with MPE and no previous pleurodesis, with comparable survival and equivalent relief of breathlessness. Additionally, the TP group had higher pleurodesis rates, less total drainage, and fewer all-grade complications (including catheter blockage and cellulitis). However, patients in the TP group had more pleural procedures and relatively longer hospital stays. Additionally, no apparent difference was detected in QoL.ConclusionsTP has better pleurodesis rates, less total drainage, and fewer all-grade complications. However, TP has more pleural procedures and is not feasible for patients with trapped lungs. IPC has fewer further pleural interventions and shorter hospital stays. However, IPC has the nuisance of long-term in situ draining.
Highlights
Malignant pleural effusion (MPE) affects over 750,000 patients every year across America and Europe, and its occurrence is increasing [1, 2]
Selection criteria We included studies conforming to the criteria of the PICOS model: (1) participants: patients with malignant pleural effusion (MPE) have not undergone indwelling pleural catheter (IPC) or pleurodesis treatment previously; (2) interventions and comparisons: Talc pleurodesis (TP) group vs. IPC group; (3) outcomes: survival, pleurodesis rates (defined in the TP group as no need for further pleural interventions, and defined in the IPC group as no obvious recurrence according to thoracic ultrasound or chest radiograph and no need for further pleural interventions after IPC removal following the spontaneous end of drainage [26]), total volume of drainage, symptoms, further pleural interventions, quality of life (QoL), total hospital stay, and adverse events (AEs); and (4) study design: Randomized controlled trail (RCT) written in English
Four RCTs including a total of 403 participants (TP, 203; IPC, 200) were eventually identified in our quantitative synthesis [20,21,22,23]
Summary
Malignant pleural effusion (MPE) affects over 750,000 patients every year across America and Europe, and its occurrence is increasing [1, 2]. In a recent network meta-analysis, Dipper et al. Wang et al World Journal of Surgical Oncology (2020) 18:184 suggested that talc might have the best clinical efficacy for chemical pleurodesis [14]. As an alternative form of fluid management, indwelling pleural catheter (IPC) placement is an outpatient procedure that has been suggested to be as effective as traditional methods in relieving symptoms in MPE patients [17, 18]. Several recent RCTs found no significant difference between the IPC and TP groups in palliative patient reports of dyspnea among participants with MPE and no previous pleurodesis [21,22,23]. Talc pleurodesis (TP) and indwelling pleural catheter (IPC) are used for the management of malignant pleural effusion (MPE).
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