Treatment of malignant pleural effusion by means of pleurodesis with talc through video-assisted thoracic surgery (vats): literature review
DOI:
https://doi.org/10.24054/cbs.v4i1.4298Keywords:
Malignant Pleural Effusion, Video-Assisted Thoracic Surgery, Pleurodesis, TalcAbstract
Background: Malignant pleural effusion (MPE) represents a frequent complication in patients with advanced malignancies, generating debilitating symptoms that significantly impact their quality of life. Among the palliative treatments available, talc pleurodesis by videothoracoscopy (VATS) is widely used, although there are also alternatives such as indwelling pleural catheters (IPC) and partial pleurectomy. Objective: To review the efficacy, safety and prognostic factors associated with treatments for MPD, with emphasis on VATS talc pleurodesis. Methodology: This systematic review analyses the evidence published between 2004 and 2024 on the different therapeutic interventions for the management of MPD through the Web of Science database. Only original open access articles were included; clinical trials and literature reviews were excluded. Selection criteria included patients with PMD treated with pleurodesis, IPC, HITHOC and partial pleurectomy. Results: The selected studies showed that VATS talc pleurodesis had a success rate of 85-89% and a median survival between 10.5 and 17 months. Factors such as recent use of chemotherapy, supplemental oxygen and low performance status were associated with higher complications. Alternatives such as IPC and pleurectomy proved useful in selected cases. Conclusions: Talc pleurodesis by VATS remains the treatment of choice due to its high efficacy and safety . However, treatment selection should be based on the clinical and prognostic characteristics of the patient. The need for standardised evidence-based clinical guidelines to optimise the management of MPD is highlighted.
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Gayen, S. (2022). Malignant pleural effusion: Presentation, diagnosis, and management. The American Journal of Medicine, 135(10), 1188–1192.
Skok, K., Hladnik, G., Grm, A., & Crnjac, A. (2019). Malignant pleural effusion and its current management: A review. Medicina, 55(8), 490.
Orlandi, R., Cara, A., Cassina, E. M., Degiovanni, S., Libretti, L., Pirondini, E., et al. (2024). Malignant pleural effusion: Diagnosis and treatment—Up-to-date perspective. Current Oncology, 31(11), 6867–6878.
Castaldo, N., Fantin, A., Palou-Schwartzbaum, M., Viterale, G., Crisafulli, E., Sartori, G., et al. (2024). Exploring the efficacy and advancements of medical pleurodesis: A comprehensive review of current research. Breathe, 20(2), Article 240002. https://publications.ersnet.org/content/breathe/20/2/240002
Glatt, J., & Chandar, P. (2024). The future of chemical pleurodesis: A review of novel and investigational sclerosant agents. The American Journal of the Medical Sciences, 368(3), 175–181.
Ledwani, A., Ghewade, B., Jadhav, U., Adwani, S., Wagh, P., & Karnan, A. (n.d.). Unveiling insights: A comprehensive review of the role of medical thoracoscopy in pleural effusion assessment. Cureus, 16(2), e53516.
Yoon, D. W., Cho, J. H., Choi, Y. S., Kim, J., Kim, H. K., Zo, J. I., et al. (2016). Predictors of survival in patients who underwent video-assisted thoracic surgery talc pleurodesis for malignant pleural effusion. Thoracic Cancer, 7(4), 393–398.
Gasparri, R., Leo, F., Veronesi, G., De Pas, T., Colleoni, M., Maisonneuve, P., et al. (2006). Video-assisted management of malignant pleural effusion in breast carcinoma. Cancer, 106(2), 271–276.
Diggs, L. P., Martin, S. P., Drake, J. A., & Ripley, R. T. (2021). Video-assisted thoracoscopic surgery pleurectomy: A suitable alternative for treating malignant pleural effusions. Journal of Thoracic Disease, 13(4). https://jtd.amegroups.org/article/view/51014
Markowiak, T., Ried, M., Großer, C., Hofmann, H. S., Hillejan, L., Hecker, E., et al. (2022). Postoperative outcome after palliative treatment of malignant pleural effusion. Thoracic Cancer, 13(15), 2158–2163.
Scarci, M., Caruana, E., Bertolaccini, L., Bedetti, B., Brunelli, A., Varela, G., et al. (2017). Current practices in the management of malignant pleural effusions: A survey among members of the European Society of Thoracic Surgeons. Interactive CardioVascular and Thoracic Surgery, 24(3), 414–417.
Barbetakis, N., Asteriou, C., Papadopoulou, F., Samanidis, G., Paliouras, D., Kleontas, A., et al. (2010). Early and late morbidity and mortality and life expectancy following thoracoscopic talc insufflation for control of malignant pleural effusions: A review of 400 cases. Journal of Cardiothoracic Surgery, 5(1), 27.
Kleontas, A., Sioga, A., Pandria, N., Barbetakis, N., Lazopoulos, A., Katsikas, I., et al. (2019). Clinical factors affecting the survival of patients diagnosed with non-small cell lung cancer and metastatic malignant pleural effusion, treated with hyperthermic intrathoracic chemotherapy or chemical talc pleurodesis: A monocentric, prospective, randomized trial. Journal of Thoracic Disease, 11(5). https://jtd.amegroups.org/article/view/29107
Kuzniar, T. J., Blum, M. G., Kasibowska-Kuzniar, K., & Mutlu, G. M. (2006). Predictors of acute lung injury and severe hypoxemia in patients undergoing operative talc pleurodesis. The Annals of Thoracic Surgery, 82(6), 1976–1981.
Zhang, W., Zhao, Y. L., Li, S. J., Zhao, Y. N., Guo, N. N., & Liu, B. (2021). Complications of thoracoscopic talc insufflation for the treatment of malignant pleural effusions: A meta-analysis. Journal of Cardiothoracic Surgery, 16(1), 125.
Rodrigues, A. L. S. de O., Souza, M. E. C., Moraes, F. C. A. de, Lima, D. P. de, & Carvalho, R. L. C. de. (2024). Talc slurry versus thoracoscopic talc insufflation for malignant pleural effusion: A systematic review and meta-analysis. Jornal Brasileiro de Pneumologia, 50, e20240115.
Hunt, B. M., Farivar, A. S., Vallières, E., Louie, B. E., Aye, R. W., Flores, E. E., et al. (2012). Thoracoscopic talc versus tunneled pleural catheters for palliation of malignant pleural effusions. The Annals of Thoracic Surgery, 94(4), 1053–1059.
Gonnelli, F., Hassan, W., Bonifazi, M., Pinelli, V., Bedawi, E. O., Porcel, J. M., et al. (2024). Malignant pleural effusion: Current understanding and therapeutic approach. Respiratory Research, 25(1), 47.
Nakamichi, T., Hashimoto, M., Nakamura, A., Kuroda, A., Tanaka, T., Takeuchi, J., et al. (2021). Quality of life and lung function after pleurectomy/decortication for malignant pleural mesothelioma. Interactive CardioVascular and Thoracic Surgery, 33(4), 572–579.
Asciak, R., Bedawi, E. O., Bhatnagar, R., Clive, A. O., Hassan, M., Lloyd, H., et al. (2023). British Thoracic Society clinical statement on pleural procedures. Thorax, 78(Suppl 3), S43–S68.
Fitzgerald, D. (2022). Optimising the management of pleural infection and pleural malignancy.
Migliore, M., Fiore, M., Filippini, T., Tumino, R., Sabbioni, M., Spatola, C., et al. (2023). 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. Heliyon, 9(6). https://www.cell.com/heliyon/abstract/S2405-8440(23)03892-6
ElMasry, A., Amr, M., Eldomiaty, H., & Fayad, E. S. A. (2021). Thoracoscopic talc insufflation versus talc slurry in patients with malignant pleural effusion. Suez Canal University Medical Journal. https://journals.ekb.eg/article_161152.html
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