Initial management of suspected malignant pleural effusion : videothoracoscopic ambulatory indwelling pleural catheter versus talc pleurodesis, a propensity scores matched study

Objectives To determine if ambulatory videothoracoscopic pleural sampling followed by indwelling pleural catheter (VATS-IPC) is safe and effective comparing with videothoracoscopic talc pleurodesis (VATS-TP) reducing total pleural effusion-relative hospitalization days for patients with malignant pleural effusion (MPE). Methods. All patients who underwent either ambulatory VATS- IPC or conventional VATS-TP were extracted from a prospective database. Patients were matched one to one according to the surgical strategy (VATS-IPC versus VATS-TP) and a propensity score including six variables: age, gender, PS, type and size of effusion, dyspnoea. Primary endpoint was effusion-relative hospital stay at 3 months. Secondary endpoints were occurrence of pleurodesis, additional pleural procedures and adverse events at 3 months. Results. From 2019 to 2021, among 176 patients underwent surgical procedure whose 48 an ambulatory hybrid approach by VATS-IPC. Overall effusion-relative hospital stay at 3 months was lower in the VATS-IPC group before and after propensity score (1.80 +/-3.95 vs 6.85 +/- 6.15 days, p < 0.001). Initial management length of stay was also lower in the VATS-IPC group before and after propensity score (0.81 +/- 1.27 vs 6.02 +/- 4.83, p < 0.001). Additional pleural procedure rate (11.1 vs 10.4%, p = 1.000) and pleurodesis (72.3% vs 66.7%, p = 0.706) were similar in both of groups. VATS- TP trended to be associated with more adverse events (16.7% vs 8.7%, p = 0.396). No difference of mortality at 3 months was found (18.8% vs 16.7%, p = 1.000). Conclusions. Ambulatory VATS-IPC was associated with shorter effusion-relative hospitalization stay with equivalent pleurodesis rate at 3 months, without increased morbimortality for initial management of MPE.