Pleural catheters after thoracoscopic treatment of malignant pleural effusion: a randomized comparative study on quality of life.

BACKGROUND

Malignant pleural effusion (MPE) complicates many neoplasms and its incidence is expected to rise in parallel with the aging population and longer survival of cancer patients. Although a clear consensus exists on indwelling catheters in patients with poor performance status, no study has hitherto compared different devices in patients requiring temporary or definitive drainage following talc poudrage.

METHODS

This is a prospective, two-arm, pilot study on patients with MPE undergoing talc poudrage, comparing two different catheters (PleurX versus Pleurocath) positioned because of the inefficacy of the procedure or the high risk of short-term failure. End points of the study were quality of life (QoL), median dyspnea and chest pain assessment by EORTC questionnaires and a 100 mm visual analog scale, total in-hospital length of stay and frequency of serious adverse events.

RESULTS

No difference was observed between the two groups in in mean dyspnea and mean chest pain in any questions of the EORTC QLQ-C30 and QLQ-LC13 questionnaires. Duration of the procedure was significantly longer in the PleurX group versus the Pleurocath group (72±33 versus 44±13 minutes; P=0.03). No difference was observed between the two groups in total length of hospital stay (P=1.00) or complication rate (P=1.00).

CONCLUSIONS

For the cohort of patients still needing indwelling pleural catheters (PC) after thoracoscopic talc poudrage, PleurX is suggested when drain removal is unlikely due to short life expectancy or the high chance of pleurodesis failure. Conversely, Pleurocath should be recommended in all other patients as it is faster to place and easier to remove.

KEYWORDS

Malignant pleural effusion (MPE); talc poudrage; indwelling pleural catheter (indwelling PC).