Clinical outcomes of video-assisted thoracoscopic surgery, talc pleurodesis and indwelling catheterisation for malignant pleural effusion: A retrospective comparative study.

Abstract

Introduction: Malignant pleural effusion (MPE) is a common complication of advanced cancer that impairs quality of life. The present study compared the outcomes of three procedures: tube thoracostomy with talc pleurodesis, video-assisted thoracoscopic surgery (VATS) with talc and indwelling pleural catheter (IPC).

Patients and methods: In this retrospective study, 76 MPE patients were assigned to tube + talc ( n = 29), VATS + talc ( n = 27) or IPC ( n = 20). Outcomes included pleurodesis success, complications, hospitalisation, 30-day reintervention, mortality and overall survival. Eastern Cooperative Oncology Group (ECOG) performance score and serum albumin were analysed as prognostic factors using Cox regression.

Results: IPC had the shortest hospital stay (3 days) and the highest 30-day reintervention rate (20%, P = 0.030). Pleurodesis success was 84.6% in both the tube and VATS groups. Median survival differed among groups (66 days for IPC, 95 days for tube and 118 days for VATS; P = 0.041); however, procedure type was not an independent predictor of survival, and these differences should be interpreted cautiously. ECOG ≥2 (hazard ratio [HR]: 1.74, P = 0.020) and albumin <3.0 g/dL (HR: 1.60, P = 0.040) were identified as independent predictors of poorer survival.

Conclusion: Treatment selection should primarily be based on functional and nutritional status rather than expected survival benefit. ECOG performance status and serum albumin levels should play a central role in guiding individualised management strategies.