Intrapleural fibrinolytic therapy for loculated malignant pleural effusion: A systematic review and meta-analysis

Malignant pleural effusion (MPE) is a common complication in advanced malignancies, often presenting with dyspnea and impaired quality of life. Management can be challenging, particularly in cases with loculated effusions or non-expandable lungs. Intrapleural fibrinolytic therapy (IFT) has been proposed as a potential adjunctive treatment, although its efficacy for loculated MPE remains inconclusive METHODS: A systematic search was conducted across PubMed and Embase, and a meta-analysis was conducted to assess the efficacy and safety of IFT for MPE. Eligible studies included randomized controlled trials (RCTs) and retrospective studies comparing IFT with control interventions. The primary outcome was respiratory improvement; secondary outcomes included complication rates, treatment failure or clinical recurrence, hemorrhagic complications, and hospital length of stay.

Six studies (n = 653) were included, comprising three RCTs and three retrospective cohort studies. IFT was associated with significantly greater respiratory improvement (OR = 5.25, 95 % CI: 3.54-7.80, p < 0.05), with consistent findings in both RCT and retrospective subgroups. There were no statistically significant differences in overall complication rates, treatment failure, hemorrhagic complications, or length of hospital stay. Subgroup analyses revealed a higher complication OR in retrospective studies (OR = 3.36) and a lower OR in RCTs (OR = 0.78), although both were statistically non-significant.

IFT is associated with favorable respiratory outcomes in patients with MPE with an acceptable safety profile, suggesting its potential role as an adjunct to standard therapies.