Quality of Life and Outcomes after Nonintubated versus Intubated Video-Thoracoscopic Pleurodesis for Malignant Pleural Effusion: Comparison by a Case-Matched Study.

Background: Malignant pleural effusion can be successfully treated by video assisted thoracic surgery (VATS) talc pleurodesis. This procedure can be also performed using local anesthesia on non-intubated patients. Objectives: To evaluate quality of life and major outcomes after VATS talc pleurodesis performed under local anesthesia in non-intubated patients with malignant pleural effusion. Design: Retrospective, non-randomized case-matched comparison (non-intubated Vs intubated) pairing the patients by computer according to their clinical features. Setting/Subjects: Since 2002 231 consecutive patients underwent uniport VATS talc pleurodesis under local anesthesia (non-intubated group). These patients were case-to-case matched with 231 homogeneous subjects, selected from a larger group who preferred general anesthesia (intubated group) in the same period. Measurements: Quality of life (European Organization for Research and Treatment of Cancer QLQ-C30 core questionnaire) and other major outcomes were considered. Results: Pleurodesis was successful in 198 (85.7%) in non-intubated and 193 (83.5%) in intubated patients, but the former group showed shorter total operative room time (65.8±7.5 Vs 84.9±13.3 min, p<0.0001), duration of postoperative pleural fluid leakage (2.5±1.0 Vs 4.0±1.5 days, p=0.014), postoperative hospital stay (3.1±2.5 Vs 4.9±2.8 days, p=0.011) as well as lower perioperative mortality (0% Vs 2.3%, p=0.017), morbidity (5.2% Vs 9.0%, p=0.042) and economical costs (6,090±517 Vs 9,660±713€, p=0.015). Quality of life presented a similar evolution between groups, however the early postoperative improvement in Physical Function (p<0.05), Global Health (p<0.05) and Dyspnea (p<0.01) was significantly greater in non-intubated patients. Significant improvements in respiratory exchanges, postoperative acute stress markers and mental confusion were also documented. Effusion-free (p=0.35) and overall (p=0.52) survivals were similar between groups. Conclusion: Non-intubated VATS talc pleurodesis can achieve similar results in pleural effusion than same operation performed under general anesthesia, but with earlier improvement of some quality of life domains as well as better mortality, morbidity, hospital stay and costs.