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The Annals of Thoracic Surgery Jan 2019Pleurectomy/decortication is a surgical procedure for malignant pleural mesothelioma (MPM) and has been proposed as an alternative to extrapleural pneumonectomy. We...
Pleurectomy/decortication is a surgical procedure for malignant pleural mesothelioma (MPM) and has been proposed as an alternative to extrapleural pneumonectomy. We report a second primary lung cancer developing after pleurectomy/decortication for MPM. A 59-year-old man was diagnosed with MPM on the right side and underwent pleurectomy/decortication. Follow-up computed tomography detected a nodule in the right upper lobe that was diagnosed as adenocarcinoma by wedge resection. Lung cancer and MPM are associated with asbestos exposure. However, predicting lung cancer after treatment for MPM is difficult. Careful follow-up of the spared lung is necessary for detecting second primary lung cancer or MPM recurrence.
PubMed: 30558734
DOI: 10.1016/j.athoracsur.2018.05.087 -
Interactive Cardiovascular and Thoracic... Oct 2022Although the diagnosis of malignant pleural mesothelioma at an in situ stage was traditionally challenging, it is now possible owing to advances in molecular biological...
Although the diagnosis of malignant pleural mesothelioma at an in situ stage was traditionally challenging, it is now possible owing to advances in molecular biological methods such as P16 fluorescence in situ hybridization or BRCA1-associated protein 1 immunohistochemistry. Here, we report the first case, to our knowledge, of total parietal pleurectomy for mesothelioma in situ. Future follow-up and accumulation of cases are necessary to determine whether total parietal pleurectomy could be applied as a treatment for mesothelioma in situ or not.
Topics: Humans; Mesothelioma, Malignant; Pleural Neoplasms; In Situ Hybridization, Fluorescence; Lung Neoplasms; Mesothelioma
PubMed: 36205712
DOI: 10.1093/icvts/ivac255 -
Monaldi Archives For Chest Disease =... Sep 2022Thoracic endometriosis is very rare. Usually, the thorax is the most frequent affected site outside the pelvis. Common symptoms include chest pain, dyspnea, and...
Thoracic endometriosis is very rare. Usually, the thorax is the most frequent affected site outside the pelvis. Common symptoms include chest pain, dyspnea, and hemoptysis. Common manifestations include pneumothorax, hemothorax, and pulmonary or pleural nodules. In addition, symptoms and manifestations can be "catamenial" happening a few days after menstruation onset. This disease can be debilitating, causing a significant impact on the quality of life of young women. We present a case of a young female who was referred to our hospital with recurrent right-sided pleural effusions and pneumothoraces. Pleural fluid drainage was consistent with hemothorax. Transvaginal ultrasound showed mild intraperitoneal fluid in the Cul-de-Sac. Due to concerns for thoracic endometriosis, video-assisted thoracoscopic surgery was performed confirming the diagnosis by pathology. Therapeutic pleurectomy with diaphragmatic repair and pleurodesis was performed. The patient was started on medroxyprogesterone acetate injections two weeks after with great clinical response.
Topics: Female; Humans; Endometriosis; Hemothorax; Hemopneumothorax; Quality of Life; Pneumothorax; Thoracic Surgery, Video-Assisted
PubMed: 36172717
DOI: 10.4081/monaldi.2022.2401 -
Revue de Pneumologie Clinique Oct 2018Malignant pleural mesothelioma (MPM) is a rare and highly aggressive disease, whose incidence is increasing. Asbestos is the primary causal agent. (Review)
Review
INTRODUCTION
Malignant pleural mesothelioma (MPM) is a rare and highly aggressive disease, whose incidence is increasing. Asbestos is the primary causal agent.
STATE OF KNOWLEDGE
Knowledge about MPM has evolved. Thoracoscopy is essential for diagnosis of MPM. It allows performing pleural biopsies, to study the extent of the disease and to relieve dyspnea. The pathological diagnosis is also better codified with immunohistochemistry and with analysis by expert of Mesopath group. Curative surgical treatments are pleurectomy decortication and extended pneumonectomy in combination with chemotherapy and/or radiotherapy. Those heavy treatments improve survival in highly selected patients. For the other patients, supportive measures will be considered to reduce pain and dyspnea.
PROSPECT
Radical surgical treatment is only offered in therapeutic trials or multimodal treatment. Its place is not formally established. New therapies associated to surgical treatment are being studied.
CONCLUSIONS
Surgical management of MPM has to be operated in specialized teams where the survival benefit and quality of life is discussed case by case.
Topics: Chemotherapy, Adjuvant; Combined Modality Therapy; Humans; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Pleural Neoplasms; Pneumonectomy; Radiotherapy, Adjuvant; Thoracic Surgical Procedures; Thoracoscopy; Treatment Outcome
PubMed: 30316650
DOI: 10.1016/j.pneumo.2018.09.006 -
The Clinical Respiratory Journal Jul 2018This article aims to review the evidence from recent clinical trials in mesothelioma, and to provide an overview of relevant clinical trials that are currently in... (Review)
Review
OBJECTIVES
This article aims to review the evidence from recent clinical trials in mesothelioma, and to provide an overview of relevant clinical trials that are currently in progress.
DATA SOURCE
Ovid MEDLINE, 1946 to present.
STUDY SELECTION
Clinical trials of therapeutic interventions were considered for inclusion, regardless of phase. Of 258 papers identified in the literature search, 88 were potentially eligible based on abstract screening. Following evaluation of full-text articles, 35 were selected for inclusion in the review.
RESULTS
Since the original trial that demonstrated the efficacy of pemetrexed and cisplatin in mesothelioma, multiple trials have been conducted that have further informed management options. Anti-angiogenesis agents such as bevacizumab and nintedanib appear promising as adjuncts to first-line chemotherapy. Meanwhile, immunotherapy, anti-mesothelin agents and molecular targeted therapies are potential areas for development, with ongoing trials promising to deliver interesting results over the next few years. Current evidence does not support surgical intervention; however, investigations are ongoing as to the role of extended pleurectomy/decortication, and surgery in the context of trapped lung. Finally radiotherapy is effective as a palliative measure for pain control, but is not indicated prophylactically to prevent the development of procedure tract metastases.
CONCLUSION
A large amount of high-quality mesothelioma research has been conducted in the past decade. As a result, several new therapies are likely to become available in clinical practice in the near future. With multiple trials ongoing, the horizon for patients with mesothelioma looks brighter than ever before.
Topics: Angiogenesis Inhibitors; Antineoplastic Agents; Clinical Trials as Topic; Humans; Immunotherapy; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Molecular Targeted Therapy; Pulmonary Surgical Procedures; Radiotherapy; Treatment Outcome
PubMed: 30129116
DOI: 10.1111/crj.12938 -
Cureus Jun 2019We report the first case report of postpartum bilateral tension pneumothoraces. A 31-year-old primigravida presented with obstructive shock and respiratory failure five...
We report the first case report of postpartum bilateral tension pneumothoraces. A 31-year-old primigravida presented with obstructive shock and respiratory failure five days following a normal spontaneous vaginal delivery. Bilateral surgical chest drains were inserted and following computed tomography suggestive of an underlying interstitial lung disease she was transferred to a tertiary cardiothoracic centre. Video-assisted thoracic surgery was carried out with left apicectomy and parietal pleurectomy. Histopathology supported a diagnosis of pulmonary lymphangioleiomyomatosis. We discuss the pathophysiology of labour-induced barotrauma and examine pertinent elements of the acute management of this case.
PubMed: 31410339
DOI: 10.7759/cureus.4856 -
Cureus Apr 2021The group (SAG) consists of three bacteria (, , and ) that are known commensals of the upper respiratory, digestive, and reproductive tracts. While a rare occurrence,...
The group (SAG) consists of three bacteria (, , and ) that are known commensals of the upper respiratory, digestive, and reproductive tracts. While a rare occurrence, these bacteria have the capability of causing devastating pyogenic infections and ensuing abscess formations. It is often difficult to distinguish this group as a contaminant or the offending organism (as it is often cultured in respiratory specimens); therefore, it is important to understand the risk factors, clinical presentation, and diagnostic findings that can provide a more accurate picture to identify the organism. Published literature pertaining to the SAG group has rarely documented any invasive surgical intervention that was undertaken for treatment. We describe a case of a 59-year-old male who presented for persistent chest pain and profuse productive cough weeks after he was diagnosed with a left lower extremity deep vein thrombosis and right-sided pulmonary embolism. The patient was found to have a rapidly evolving right middle lobe lung abscess complicated by a right hemithorax empyema. Management included an exploration of the right chest, decortication, parietal pleurectomy, and partial excision of the right middle lobe. Subsequently, the patient completed four weeks of antibiotics with ertapenem.
PubMed: 34017651
DOI: 10.7759/cureus.14534 -
F1000Research 2018Malignant pleural mesothelioma (MPM) is a rare disease of the pleura and is largely related to asbestos exposure. Despite recent advancements in technologies and a... (Review)
Review
Malignant pleural mesothelioma (MPM) is a rare disease of the pleura and is largely related to asbestos exposure. Despite recent advancements in technologies and a greater understanding of the disease, the prognosis of MPM remains poor; the median overall survival rate is about 6 to 9 months in untreated patients. The main therapeutic strategies for MPM are surgery, chemotherapy, and radiation therapy (RT). The two main surgical approaches for MPM are extrapleural pneumonectomy (EPP), in which the lung is removed en bloc, and pleurectomy/decortication, in which the lung stays . Chemotherapy usually consists of a platinum-based chemotherapy, such as cisplatin, often combined with a folate antimetabolite, such as pemetrexed. More recently, immunotherapy has emerged as a possible therapeutic strategy for MPM. Evidence suggests that single-modality treatments are not an effective therapeutic approach for MPM. Therefore, researchers have started to explore different multimodality treatment approaches, in which often combinations of surgery, chemotherapy, immunotherapy, and RT are investigated. There is still no definitive answer to the question of which multimodality treatment combinations are most effective in improving the poor prognosis of MPM. Research into the effects of trimodality treatment approaches have found that radical approaches such as EPP and hemithoracic RT post-EPP are less effective than was previously assumed. In general, there are still a great number of unanswered questions and unknown factors regarding the ideal treatment approach for MPM. Hopefully, more research into multimodality therapy will provide insight into which combination of treatment modalities is most effective.
Topics: Animals; Combined Modality Therapy; Humans; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Pleura; Rare Diseases; Treatment Outcome
PubMed: 30410726
DOI: 10.12688/f1000research.15796.1 -
Journal of Thoracic Disease Nov 2021This observational study evaluates retrospectively the long-term outcomes after pleurectomy/decortication for pleural mesothelioma, with and without the...
BACKGROUND
This observational study evaluates retrospectively the long-term outcomes after pleurectomy/decortication for pleural mesothelioma, with and without the resection/reconstruction of diaphragm and pericardium.
METHODS
Data from 155 consecutive patients undergoing lung-sparing surgery for epithelial pleural mesothelioma were reviewed. Selection criteria for surgery were cT1-3, cN0-1, good performance status, age <80 years. Perioperative Pemetrexed-Platinum regimen was administered as induction in 101 cases (65.2%) and as adjuvant treatment in 54 cases (34.8%). Extended pleurectomy/decortication was performed in 87 cases (56.12%). In 68 patients (43.87%) standard pleurectomy/decortication was performed without resection/reconstruction of diaphragm and pericardium, when tumour infiltration was deemed absent after intraoperative frozen section. The log-rank test and Cox regression model were used to assess the factors affecting overall survival and recurrence free survival.
RESULTS
Median follow-up was 20 months. The 2- and 5-year survival rate was 60.9% and 29.2% with a median survival of 34 months. An improved survival was observed when standard pleurectomy/decortication was carried out (P=0.007). A significant impact on survival was found comparing the TNM-stages (P=0.001), pT (P=0.002) and pN variables (P=0.001). Multivariate analysis identified the pN-status (P=0.003) and standard pleurectomy/decortication (P=0.017) as predictive for longer survival. The recurrence-free survival >12 months was strongly related to the overall survival (P<0.001). The macroscopic complete resection (P=0.001), TNM-stage (P=0.003) and pT-status (P=0.001) are related to relapse.
CONCLUSIONS
Within multimodal management of pleural mesothelioma, lung-sparing surgery is a valid option even with more conservative technique. A benefit for a longer survival was observed in the early stage of disease, with pN0 and when pleurectomy/decortication is carried out, preserving diaphragm and pericardium. Recurrence is not affected by the type of surgery, and a recurrence-free interval >12 months is predictive of an increased survival when the macroscopic complete resection is achieved.
PubMed: 34992808
DOI: 10.21037/jtd-21-691 -
Expert Review of Respiratory Medicine Jan 2018Optimal management of malignant pleural effusion (MPE) is important in the care of patients with advanced cancer. Surgical (especially video-assisted thoracoscopic... (Review)
Review
Optimal management of malignant pleural effusion (MPE) is important in the care of patients with advanced cancer. Surgical (especially video-assisted thoracoscopic surgery (VATS)) and non-surgical strategies are available. Clinicians should be aware of the evidence supporting the use of different modalities to guide treatment choice. Areas covered: This review covers published evidence of the advantages and disadvantages of VATS and non-surgical alternatives for MPE management. Expert commentary: Randomized clinical trials (RCTs) are needed to define the roles and benefits of VATS as existing literature is often flawed by selection bias. Three RCTs have failed to show benefits of VATS talc poudrage over bedside talc pleurodesis. VATS-pleurectomy offered no survival advantage in a RCT of mesothelioma patients. Modification of VATS techniques has reduced the invasiveness and associated risks. Future trials should compare VATS with contemporary, non-surgical approaches (especially combined Indwelling Pleural Catheter (IPC) and chemical pleurodesis therapy). Individualized management for different subgroups of MPE patients should be a long-term research goal. Studies are needed on better patient selection, and adjunct non-invasive, supportive (e.g. nutrition and exercise) therapies.
Topics: Disease Management; Female; Humans; Male; Pleural Effusion, Malignant; Thoracic Surgery, Video-Assisted; Treatment Outcome
PubMed: 29111830
DOI: 10.1080/17476348.2018.1398085