Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis

Our plain-English summary of Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis, by T. Laisaar, V. Palmiste, T. Vooder, et al (Interactive Cardiovascular and Thoracic Surgery, 2006).

The study

• Authors: T. Laisaar, V. Palmiste, T. Vooder, T. Umbleja
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2006;5(3):307-10
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The aim of the current study was to analyse postoperative complications and survival after video-assisted thoracoscopic (VATS) talc pleurodesis for malignant pleural effusion. All patients with morphologically proven malignant pleural effusion who underwent VATS talc pleurodesis from November 1995 to November 2002 were included in retrospective analysis. VATS was performed in general anaesthesia and 5 g of asbestos-free talc was insufflated into the pleural cavity. Postoperative pleural drainage was used until fluid output was less than 100 ml/24 h. Ninety-eight patients (28 male and 70 female) with mean age 59.6 (range 18-82) years were included. Thirteen patients had a bilateral pleural effusion. The most common primary cancer sites were lung (30 cases), breast (25) and ovarium (11). Average duration of the operation was 46 (range 10-120) min. Median duration of postoperative drainage was 3 (range 1-20) days and postoperative hospitalisation 7 (range 3-70) days. Twenty-eight patients had postoperative complications (fever in 17 cases). In seven cases pleurodesis was ineffective. Median survival was 8.4 months. Six-, 12- and 24-month survival was 58% (95% CI [0.47-0.67]), 39% [0.29-0.49] and 20% [0.12-0.29], respectively. Survival data after VATS talc pleurodesis advocate use of this invasive treatment method despite the advanced stage of cancer.

In plain English

This retrospective study from Tartu University Clinics, Estonia, covered all 98 patients who had video-assisted thoracoscopic (VATS) talc pleurodesis for malignant pleural effusion (fluid around the lung caused by cancer) from November 1995 to November 2002. The procedure blew 5 g of asbestos-free talc into the chest cavity; asbestos exposure was not studied. The most common cancers were lung (30), breast (25) and ovarian (11), and 7 patients had malignant pleural mesothelioma. After 101 operations, 28 patients had 33 complications, most often fever (17 cases). Six died in hospital after surgery. Median survival was 8.4 months (survival data were missing for one patient). Survival was 58% at 6 months, 39% at 12 months and 20% at 24 months (95% confidence intervals 0.47 to 0.67, 0.29 to 0.49 and 0.12 to 0.29). Survival did not differ significantly by age or cancer type. The authors concluded that patients with metastases at multiple sites, beyond the pleura, need less invasive treatment because of a high risk of post-operative death. Otherwise, with proper patient selection, reasonable survival can be expected. The authors could not determine every patient's performance status.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective study of consecutive patients at one hospital (institutional report)
• Who was studied: 98 patients (28 male, 70 female; mean age 59.6, range 18 to 82) with malignant pleural effusion who had 101 VATS talc pleurodesis operations at Tartu University Clinics, Estonia, November 1995 to November 2002
• Exposure: Not an asbestos exposure study. The treatment studied was VATS pleurodesis with 5 g of asbestos-free talc powder insufflated into the pleural cavity.
• Main results:
  • Primary cancers were lung 30, breast 25 and ovaries 11. Adenocarcinoma of unknown origin caused the effusion in 8 patients and malignant pleural mesothelioma in 7.
  • After 101 operations, 28 patients had a total of 33 post-operative complications.
  • Fever was the most common complication, occurring in 17 cases.
  • Six patients died in hospital after the operation. The results section states that five had distant metastases beyond the pleura and one had far advanced lymphoma.
  • Pleurodesis was ineffective in 7 cases: 4 due to a residual cavity and 3 due to permanent fluid discharge. For the latter 3, talc slurry was given through the chest tube, with an excellent final result reported in all.
  • Median post-operative survival for all patients was 8.4 months. Survival data were available for all patients except one, and 16 were alive at the time of analysis.
  • Estimated survival for all patients was 58% at 6 months (95% CI 0.47 to 0.67), 39% at 12 months (0.29 to 0.49) and 25% at 18 months (0.17 to 0.35).
  • Estimated survival for all patients was 20% at 24 months (0.12 to 0.29).
  • Survival did not differ statistically by age (P = 0.46) or by cancer type. Median survival was 9.1 months for lung cancer, 7.7 months for breast cancer, 3.3 months for ovarian cancer and 10 months for other cancers combined (P = 0.7). Mesothelioma was not analysed separately.
  • Median post-operative drainage lasted 3 days (range 1 to 20). Median hospital stay was 7 days (range 3 to 70), falling from 9 days in the first half of the study to 5 days in the second (P = 0.0004).
• The authors' conclusion: The authors concluded that patients with multiple sites of metastases require less invasive treatment because of the high risk of post-operative death after talc pleurodesis. In other cases, after proper patient selection, reasonable survival can be expected after VATS talc pleurodesis.
• Limitations the authors state:
  • Because the study was retrospective, the authors could not determine the performance status of all patients.
  • The authors did not analyse the long-term effect of the pleurodesis itself.

Topics

Medical terms in this study, explained in our Lexicon: Life Expectancy, Pleural Effusion, Talc Pleurodesis, Video-Assisted Thoracoscopic Surgery (VATS), Asbestos-Free Talc, Pleural Cavity, Bilateral, Pleurodesis.

Related studies

• Comparison of video-assisted pleurectomy/decortication surgery plus hyperthermic intrathoracic chemotherapy with VATS talc pleurodesis for the treatment of malignant pleural mesothelioma: A pilot study — M. Migliore, M. Fiore, et al. (2023)
• MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial — C. Matthews, C. Freeman, et al. (2019)
• Should all patients who have mesothelioma diagnosed by video-assisted thoracoscopic surgery have their intervention sites irradiated? — M. Nagendran, A. Pallis, et al. (2011)
• The MesoVATS trial: is there a future for video-assisted thoracoscopic surgery partial pleurectomy? — R.C. Rintoul (2015)
• Value of autofluorescence in video-assisted thoracoscopic surgery in pleural diseases — S.T. Liman, A. Elicora, et al. (2013)
• Video assisted thoracoscopic and open chest surgery in diagnosis and treatment of malignant pleural diseases — P. Perikleous, D.A. Waller (2017)

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