The benefits of a procedure to remove part of the lung lining under video guidance may not be worth the risks and cost for patients with malignant pleural mesothelioma. That is the conclusion of researchers in the UK who studied the procedure over a nine-year period.
The treatment, called Video-Assisted Thoracoscopic Partial Pleurectomy is sometimes recommended as a way to control pleural effusions (fluid buildup) that can occur between the layers of the lung lining in pleural mesothelioma. But cancer researchers writing in the British medical journal The Lancet have concluded that a less invasive procedure called talc pleurodesis produces fewer complications and shorter hospital stays.
The researchers conducted a randomized, controlled trial of 175 mesothelioma patients with pleural effusions between October 2003 and January 2012. During the MesoVATS study, patients were randomly assigned to receive either VAT-PP or talc pleurodesis, which involves draining off the fluid and filling the space with talc to encourage the pleural layers to stick together. Eighty-eight mesothelioma patients ended up having the talc pleurodesis procedure while 87 were treated with VAT-PP.
“Surgical complications were significantly more common after VAT-PP than after talc pleurodesis, occurring in 24 of 78 patients who completed VAT-PP versus 10 of the 73 patients who completed talc pleurodesis,” writes the study’s primary author, Robert Rintoul, MD, with the Department of Thoracic Oncology at Papworth Hospital in Cambridge, UK.
The study found that the VAT-PP group also had more respiratory complications and air leaks than the mesothelioma patients who had talc pleurodesis. The median hospital stay for VAT-PP patients was more than twice as long as it was for those who had talc pleurodesis (7 days vs. 3 days). Although the difference in overall survival was only slight, it also appeared to favor those who had talc pleurodesis; 57% of the talc pleurodesis patients were still alive at one year while only 52% of VAT-PP patients lived that long. VAT-PP is also significantly more expensive than talc pleurodesis.
The researchers conclude that VAT-PP is not recommended as a way to improve overall survival in people suffering from pleural effusions because of mesothelioma. They suggest that fewer complications, shorter hospital stays, and lower cost will continue to make traditional talc pleurodesis a better option for most mesothelioma patients.
Source: Rintoul, RC et al, “Efficacy and cost of video-assisted thoracoscopic partial pleurectomy versus talc pleurodesis in patients with malignant pleural mesothelioma: an open-label, randomized, controlled trial”, June 14, 2014, Epub ahead of print