TY - JOUR
T1 - Surgical and non-surgical management of malignant pleural effusions
AU - Fitzgerald, Deirdre B.
AU - Koegelenberg, Coenraad F.N.
AU - Yasufuku, Kazuhiro
AU - Lee, Y. C.Gary
PY - 2018/1/2
Y1 - 2018/1/2
N2 - 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.
AB - 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.
KW - indwelling pleural catheter
KW - Malignant pleural effusion
KW - mesothelioma
KW - pleurodesis
KW - talc slurry
KW - video-assisted thoracoscopic surgery
UR - http://www.scopus.com/inward/record.url?scp=85038230513&partnerID=8YFLogxK
U2 - 10.1080/17476348.2018.1398085
DO - 10.1080/17476348.2018.1398085
M3 - Review article
C2 - 29111830
AN - SCOPUS:85038230513
VL - 12
SP - 15
EP - 26
JO - Expert Review of Respiratory Medicine
JF - Expert Review of Respiratory Medicine
SN - 1747-6348
IS - 1
ER -