Talc pleurodesis versus indwelling pleural catheter among patients with malignant pleural effusion: a meta-analysis of randomized controlled trials

Abstract

Background: Talc 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. Methods: We 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. Results: We 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. Conclusions: TP 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.

Postoperative outcome after palliative treatment of malignant pleural effusion

“…There are already retrospective as well as prospective studies to compare VATS talc pleurodesis and the implantation of an IPC in the treatment of MPE. However, the conclusions of these studies differ and the cohorts studied are often small, despite the high incidence of this disease 18,20–22 …”

“…However, the conclusions of these studies differ and the cohorts studied are often small, despite the high incidence of this disease. 18,[20][21][22] The objective of this registry-based study was to evaluate treatment data and postoperative outcome after VATS talc pleurodesis compared to the implantation of an IPC in the treatment of MPE. The results should provide an overview of the surgical treatment situation for patients with MPE in Germany.…”

Treating Recurrent Pleural Disease: A Review of Indications and Technique for Chemical Pleurodesis for the Interventional Radiologist

“…It is important to involve patients in weighing this decision given the various advantages and disadvantages of these treatment options. 29,30 Studies on catheter-based talc pleurodesis of recurrent transudative effusions are fewer and less robust, but hint at high rates of pleurodesis. TPC autopleurodesis rates in these patients are variable, indicating the need for additional large-scale studies.…”

“…If patients lack resources for followup and home care, or if there is a higher risk of infection, then pleurodesis may be favored over TPC. [30][31][32] In instances when life expectancy is less than 90 days and accumulation of fluid is slow, repeated large-volume thor-acentesis may be considered for palliation. 1,28 However, in most cases large volume thoracentesis is not a definitive therapy and generally not recommended for treating MPE.…”

“…If patients lack resources for follow-up and home care, or if there is a higher risk of infection, then pleurodesis may be favored over TPC. 30 31 32…”