Efficacy and Safety of Tunneled Pleural Catheters in Adults with Malignant Pleural Effusions: A Systematic Review

作者：Margaret E. M. Van Meter, Kanako Y. McKee, R. Jeffrey Kohlwes · 发表于：Journal of General Internal Medicine · 年份：2010 · DOI：10.1007/s11606-010-1472-0 · 被引用次数：286 · 研究领域：Pleural and Pulmonary Diseases、Lymphatic Disorders and Treatments、Ultrasound in Clinical Applications

BACKGROUND: Malignant pleural effusions (MPE) are a frequent cause of dyspnea and discomfort at the end of cancer patients' lives. The tunneled indwelling pleural catheter (TIPC) was approved by the FDA in 1997 and has been investigated as a treatment for MPE. OBJECTIVE: To systematically review published data on the efficacy and safety of the TIPC for treatment of MPE. DESIGN: We searched the MEDLINE, EMBASE, and ISI Web of Science databases to identify studies published through October 2009 that reported outcomes in adult patients with MPE treated with a TIPC. Data were aggregated using summary statistics when outcomes were described in the same way among multiple primary studies. MAIN MEASURES: Symptomatic improvement and complications associated with use of the TIPC. KEY RESULTS: Nineteen studies with a total of 1,370 patients met criteria for inclusion in the review. Only one randomized study directly compared the TIPC with the current gold standard treatment, pleurodesis. All other studies were case series. Symptomatic improvement was reported in 628/657 patients (95.6%). Quality of life measurements were infrequently reported. Spontaneous pleurodesis occurred in 430/943 patients (45.6%). Serious complications were rare and included empyema in 33/1168 patients (2.8%), pneumothorax requiring a chest tube in 3/51 (5.9%), and unspecified pneumothorax in 17/439 (3.9%). Minor complications included cellulitis in 32/935 (3.4%), obstruction/clogging in 33/895 (3.7%) and unspec...