Video-assisted thoracoscopic surgery versus chemical pleurodesis via chest tube in malignant pleural effusion management: a randomized clinical trial

Abstract

Background

Malignant pleural effusion (MPE) is a frequent and debilitating complication of advanced malignancy, often resulting in significant morbidity and impaired quality of life. The optimal approach for durable pleural control and symptom relief remains debated. This randomized controlled trial compared the efficacy and clinical outcomes of video-assisted thoracoscopic surgery (VATS) pleurodesis versus conventional thoracostomy tube drainage with chemical pleurodesis in patients with MPE. A total of 100 patients with a confirmed MPE diagnosis were randomized equally into two groups (
n
 = 50 each): VATS pleurodesis and thoracostomy tube drainage with bleomycin pleurodesis. The primary endpoint was successful pleurodesis (complete response) after 30 days. Secondary outcomes included hospital stay, pain score, postoperative performance status, and complications.



Results

VATS achieved a significantly higher pleurodesis success rate (90% vs 72%;
p
 = 0.022) and better postoperative performance status (ECOG I: 50% vs. 10%;
p
 < 0.001). Median hospital stay was shorter in the VATS group (4 vs. 7.5 days;
p
 < 0.001), and postoperative pain scores were lower (
p
 = 0.039). Both interventions improved dyspnea scores significantly (
p
 < 0.001). No significant differences were observed in ICU admission (36% vs 38%;
p
 > 0.05) or complication rates.



Conclusions
VATS pleurodesis using mechanical abrasion and/or electrocautery provides superior short-term outcomes compared with thoracostomy tube drainage with bleomycin pleurodesis for malignant pleural effusion, offering higher treatment success, improved functional recovery, reduced postoperative pain, and shorter hospitalization without added morbidity.