Randomised pilot and feasibility study comparing video-assisted thoracoscopic partial pleurectomy-decortication with indwelling pleural catheter for trapped lung in pleural mesothelioma

MesoTRAP aimed to provide preliminary data comparing the efficacy of indwelling pleural catheter (IPC) versus video-assisted thoracoscopic pleurectomy-decortication for trapped lung in pleural mesothelioma. Trapped lung prevalence was 11% (110/988). Over 31 months, 17 centres randomised 10 patients versus 38 planned. Thirteen non-randomised patients entered an observational substudy. Nine randomised patients reported daily visual analogue scale scores for pain and dyspnoea, but measurements varied substantially within and between patients, precluding meaningful analysis. Slow recruitment due to poor performance status precluding surgery prohibits a full trial. In the absence of high-level evidence, we conclude that the least invasive approach to trapped lung, namely IPC, should be considered in line with current guidance. Trial registration number NCT03412357.