The MesoVATS trial: is there a future for video-assisted thoracoscopic surgery partial pleurectomy?

Our plain-English summary of The MesoVATS trial: is there a future for video-assisted thoracoscopic surgery partial pleurectomy?, by R.C. Rintoul (Future Oncology, 2015).

The study

• Author: R.C. Rintoul
• Journal: Future Oncology
• Published: 2015;11(24 Suppl):15-7
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma, a uniformly fatal cancer caused by prior asbestos exposure, places a major burden on society. The MesoVATS trial was a multicenter randomized controlled trial that examined the role of video-assisted thoracoscopic partial pleurectomy (VAT-PP) versus talc pleurodesis in patients with malignant pleural mesothelioma. Overall there was no difference in survival between VAT-PP and talc pleurodesis. VAT-PP resulted in more complications, longer hospital stay and was more expensive. However, there was some evidence that VAT-PP improved EQ5D measured quality of life after 6 months particularly in the European Organisation for Research and Treatment of Cancer low-risk subgroup. At present the future role of VAT-PP is uncertain and may merit further investigation but this should be within the context of clinical trials. VAT-PP may also have a role to play in the specific situation of trapped lung.

In plain English

This short symposium article, by the trial's lead author, summarized the MesoVATS trial, published in full in 2014. The trial randomly assigned patients with confirmed or suspected malignant pleural mesothelioma and fluid around the lung (pleural effusion) to one of two treatments. One was video-assisted thoracoscopic partial pleurectomy (VAT-PP), keyhole surgery to remove part of the lining around the lung. The other was talc pleurodesis, which uses talc to seal the space around the lung. Nine UK sites randomized 196 patients between 2003 and 2012. The main analysis included 87 VAT-PP and 88 talc patients. One-year survival was 52% after VAT-PP and 57% after talc, with no significant difference. VAT-PP controlled fluid better at 1 and 6 months, but not at 9 and 12 months. It also meant longer hospital stays and more complications. Among patients with complete economic data, EQ5D quality-of-life scores favored VAT-PP at 6 and 12 months, but its cost per quality-adjusted life year was GB£109,028. The author concluded that further study of VAT-PP in low-risk patients should be done within a clinical trial.

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: Short article in a symposium supplement summarizing the MesoVATS trial, an open-label, parallel-group, multicenter randomized controlled trial whose full report was published in the Lancet in 2014
• Who was studied: 196 patients with confirmed (120) or suspected (76) malignant pleural mesothelioma and pleural effusion, randomized at nine UK sites between 2003 and 2012. 21 suspected cases turned out not to have mesothelioma and were excluded, leaving 87 in the VAT-PP arm and 88 in the talc arm. Mean age was 69, 86% were male, and 75% had prior known asbestos exposure.
• Exposure: The study compared two treatments, not asbestos exposure. VAT-PP (partial parietal pleurectomy with decortication of the visceral pleura where appropriate) was compared with talc pleurodesis (talc slurry through a chest drain, or talc poudrage at thoracoscopy). 75% of patients had prior known asbestos exposure.
• Main results:
  • One-year survival (the primary outcome) was 57% in the talc group and 52% in the VAT-PP group (hazard ratio 1.03, 95% CI 0.76–1.42; p = 0.83). Median survival was 13.5 and 13.1 months, respectively.
  • Pleural effusion was controlled in 37% of talc and 59% of VAT-PP patients at 1 month (p = 0.008), and in 57% and 76% at 6 months (p = 0.04). Control was similar in both groups at 9 and 12 months.
  • Hospital stay was longer in the VAT-PP group: median 8 days (range 1–31) versus 6 days (range 1–15) in the talc group (p < 0.001).
  • The VAT-PP group had significantly more complications, mainly prolonged air leak (26% vs 8%; p = 0.009).
  • Among patients with complete economic data, EQ5D quality of life favored the VAT-PP group at 6 months (mean difference 0.08, 95% CI 0.003–0.16; p = 0.042) and at 12 months (mean difference 0.19, 95% CI 0.05–0.32; p = 0.006).
  • The cost per quality-adjusted life year gained for VAT-PP was GB£109,028 for the full study. For patients recruited in the second half of the study it fell to GB£68,600.
  • The author reported little evidence supporting VAT-PP in the EORTC high-risk group. Subgroup analysis suggested that low-risk patients may benefit the most.
• The authors' conclusion: The author concluded that, given the uncertainties, further work on the potential benefits of VAT-PP in low-risk patients should be done within a clinical trial. The author added that VAT-PP may have a role in trapped lung.
• Limitations the authors state:
  • Some patients had trapped lung, but the study did not specifically address that situation.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Video-Assisted Thoracoscopic Surgery (VATS), Pleural Mesothelioma, Asbestos Exposure, Talc Pleurodesis, Quality of Life, Clinical Trial, Trapped Lung.

Related studies

• 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)
• 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)
• 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)
• Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis — T. Laisaar, V. Palmiste, et al. (2006)

Browse more research in Future Oncology, or return to medical research.