Indwelling Pleural Catheter versus Pleurodesis for Malignant Pleural Effusions: A Systematic Review and Meta-Analysis.
Ann Am Thorac Soc. 2018 Oct 01;:
Authors: Iyer NP, Reddy CB, Wahidi MM, Lewis SZ, Diekemper RL, Feller-Kopman D, Gould MK, Balekian AA
RATIONALE: Several randomized trials have compared the efficacy of indwelling pleural catheter (IPC) versus the more traditional chemical pleurodesis in the management of malignant pleural effusion (MPE).
OBJECTIVES: As part of the American Thoracic Society's guidelines for management of MPE, we performed a systematic review and a meta-analysis to compare patient-centered outcomes with the use of tunneled pleural catheter versus chemical pleurodesis for the first-line treatment of malignant pleural effusions.
METHODS: We performed literature searches in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials comparing IPC and pleurodesis in adult patients with symptomatic MPE. Risk of bias was assessed using the Cochrane Risk of Bias tool recommended by the Cochrane Bias Methods group. Meta-analysis was performed with Review Manager software, using a random effects model. We used risk ratios (RR) with 95% confidence interval (CI) as the effect measure for dichotomous outcomes and mean differences for continuous outcomes.
RESULTS: We identified 5 randomized trials involving 545 patients that compared IPC versus pleurodesis. Lack of blinding and the inevitable attrition of patients due to death resulted in overall high risk of bias among the studies. No differences in survival or measures of dyspnea were observed in any of the studies. Total hospital length of stay was shorter, and repeat pleural interventions were less common in the IPC group (RR 0.32; 95% CI 0.18 - 0.55). However, risk of cellulitis was higher with IPC (RR 5.83, 95% CI 1.56 - 21.8). No differences were noted in other adverse events.
CONCLUSION: Compared with chemical pleurodesis, IPC results in shorter hospital length of stay and fewer repeat pleural procedures, but carries a higher risk of cellulitis. Careful assessment of individual patient preferences and costs should be considered when choosing between IPC and pleurodesis.
PMID: 30272486 [PubMed - as supplied by publisher]