What is the best treatment for XXXX ?

@entity1 @entity1143 @entity358 @entity5033 @entity3483
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether chemical pleurodesis is superior to catheter drainage or @entity5033 ( @entity5033 ) in the management of @entity1 with @entity1143 . Overall 161 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, @entity1 group studied, study type, relevant outcomes and results are tabulated. We conclude that chemical pleurodesis is superior to chronic catheter drainage and @entity5033 in terms survival length and mortality rates but in @entity1 with @entity358 chronic intrapleural catheter placement is indicated. Six studies reported @entity1 outcomes after treatment with chemical pleurodesis. They report high success rates (89.4%) and low mortality rates (2%) without any need to convert to open thoracotomy. Mean hospital stay of 2.33 days, complication rates of 16.5% and mean survival length of 23.8    16.3 months were observed. Five studies managed @entity3483 ( @entity3483 ) using chronic indwelling catheters. They reported mean survival length of 126 days. Symptomatic relief was achieved in 94.2% of @entity1 . There was a significant reduction in the Medical Research Council dyspnoea score (3.0-1.9, P < 0.001) and despite complication rates of 22%, comparable mortality rates (7.5%) were observed. Even in @entity1 with @entity358 , mean survival length was 125 days with symptomatic improvement being achieved in 90.9% of @entity1 . Three studies treated @entity3483 using PPSs. Mean hospital stay was 6.2 days (range 2-26) with a mean survival length of 11 months. Pleurodesis success rates varied from 57.1% to 95% with a complication rate of 14.8%. PPSs were shown to produce lower success rates (57.1% vs. 92.3%), shorter survival lengths (4.3    1.9 vs. 6.7    2.1 months) and higher complication rates (14.3% vs. 2.8%) than talc pleurodesis. Overall, chemical pleurodesis is the optimal treatment option for MPE with use of chronic intrapleural catheters reserved in cases where talc pleurodesis is not possible.
