Surgical and non-surgical management of malignant pleural effusions

Deirdre B. Fitzgerald, Coenraad F.N. Koegelenberg, Kazuhiro Yasufuku, Y. C.Gary Lee

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

Introduction: Optimal management of malignant pleural effusion (MPE) is important in the care of patients with advanced cancer. Surgical (especially video-assisted thoracoscopic surgery (VATS)) and non-surgical strategies are available. Clinicians should be aware of the evidence supporting the use of different modalities to guide treatment choice. Areas covered: This review covers published evidence of the advantages and disadvantages of VATS and non-surgical alternatives for MPE management. Expert commentary: Randomized clinical trials (RCTs) are needed to define the roles and benefits of VATS as existing literature is often flawed by selection bias. Three RCTs have failed to show benefits of VATS talc poudrage over bedside talc pleurodesis. VATS-pleurectomy offered no survival advantage in a RCT of mesothelioma patients. Modification of VATS techniques has reduced the invasiveness and associated risks. Future trials should compare VATS with contemporary, non-surgical approaches (especially combined Indwelling Pleural Catheter (IPC) and chemical pleurodesis therapy). Individualized management for different subgroups of MPE patients should be a long-term research goal. Studies are needed on better patient selection, and adjunct non-invasive, supportive (e.g. nutrition and exercise) therapies.

Original languageEnglish
Pages (from-to)15-26
Number of pages12
JournalExpert Review of Respiratory Medicine
Volume12
Issue number1
DOIs
Publication statusPublished - 2 Jan 2018

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