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The Annals of Thoracic Surgery Jul 2022Pleurectomy and decortication serves as a major component of therapy for malignant pleural mesothelioma (MPM), but the procedure is time consuming. We tentatively...
Pleurectomy and decortication serves as a major component of therapy for malignant pleural mesothelioma (MPM), but the procedure is time consuming. We tentatively applied a carbon dioxide (CO) blower into pleurectomy and decortication for a patient with local relapse of MPM. The blower can help increase the potential subpleural place thanks to the positive pressure by CO, while the mist of saline could clean the potential bleeding to increase visibility. Thereby, the procedure was greatly facilitated in a more precise manner, with blood loss of 100 mL and acceptable postoperative air leak and thorax drainage. Therefore, a CO blower may be considered in pleurectomy and decortication for MPM.
Topics: Carbon Dioxide; Humans; Mesothelioma; Mesothelioma, Malignant; Neoplasm Recurrence, Local; Pleural Neoplasms; Treatment Outcome
PubMed: 34715083
DOI: 10.1016/j.athoracsur.2021.09.046 -
Journal of Clinical Medicine May 2021Mesothelioma is an aggressive disease arising from parietal pleura. Surgery is a valuable option in the frame of a multimodality treatment. Several surgical approaches... (Review)
Review
Mesothelioma is an aggressive disease arising from parietal pleura. Surgery is a valuable option in the frame of a multimodality treatment. Several surgical approaches have been standardized with the aim of a macroscopic complete resection; these often require homolateral diaphragm and pericardial resection and reconstruction. Extrapleural pneumonectomy (EPP) and extended pleurectomy decortication (EPD) have been recognized as radical surgical procedures. Nevertheless, both operations are technically challenging and associated with a significant rate of peri-operative morbidity and non-negligible mortality. The diaphragmatic and pericardial reconstruction technique is mandatory to avoid respiratory impairment and to reduce post-operative complications like gastric and cardiac herniation. Moreover, in the case of localized chest wall recurrence, surgery might be considered a valuable therapeutical option for highly selected and fit patients. All the technical aspects of the resection and reconstruction of the diaphragm, pericardium, and chest wall are described as well as the possible use of new minimally invasive techniques. In addition, the choice of different prosthetic materials, considering the most recent innovations in the field, are discussed.
PubMed: 34073544
DOI: 10.3390/jcm10112330 -
Surgical Oncology Clinics of North... Oct 2020While without treatment, malignant pleural mesothelioma (MPM) confers poor survival, cancer-directed surgery as part of multimodality treatment is associated with a 15%... (Review)
Review
While without treatment, malignant pleural mesothelioma (MPM) confers poor survival, cancer-directed surgery as part of multimodality treatment is associated with a 15% 5-year survival. Extrapleural pneumonectomy (EPP) and radical or extended pleurectomy/decortication (P/D) are the 2 types of resection performed in this context. Preoperative staging is critical to patient selection for surgery; P/D is recommended over EPP in most cases. Adjuvant therapy with intraoperative platforms, traditional chemotherapy, hemithoracic radiotherapy resection, and new immunotherapy agents are instrumental in achieving durable long-term results. We outline the latest understanding of disease staging and describe the current state of literature and practice.
Topics: Combined Modality Therapy; Disease Management; Humans; Mesothelioma, Malignant; Neoplasm Staging; Pleural Neoplasms
PubMed: 32883461
DOI: 10.1016/j.soc.2020.06.002 -
JTCVS Open Dec 2023To evaluate the efficacy of multimodality treatment including extended pleurectomy/decortication (P/D) and hyperthermic intraoperative chemotherapy (HIOC) with cisplatin...
OBJECTIVE
To evaluate the efficacy of multimodality treatment including extended pleurectomy/decortication (P/D) and hyperthermic intraoperative chemotherapy (HIOC) with cisplatin for malignant pleural mesothelioma (MPM), we investigated the pharmacokinetics of platinum, adverse events after HIOC, and survival outcome.
METHODS
Fifty-three patients with pathologically diagnosed MPM (cT1-3N0-1M0, excluding sarcomatoid) underwent an extended P/D and HIOC (cisplatin 80 mg/m in saline 2 L, 42°C, 60 minutes) since 2011. The protocol includes postoperative 4 cycles of cisplatin and pemetrexed. Platinum concentrations in the perfusate (before and after) and the serum (1, 2, 4, 8, 24, 48, 72 hours after perfusion) were measured in 10 patients. Mortality and morbidity, especially adverse events of renal function, were investigated, and survival and affecting factors were examined.
RESULTS
All patients obtained macroscopic complete resection and pathologic staging revealed as follows: T1/2/3/4: 12/8/23/10, N0/1: 36/17, stage 1A/1B-3A/3B: 12/31/10, respectively. Platinum concentrations in the perfusate indicated that 28% of the dose remained in the pleural cavity, and the maximum concentration in the serum was 0.91 μg/mL. Six patients (11%) showed elevated max-creatinine (>2 mg/dL) postoperatively. Two patients (4%) received renal-replacement therapy, and one was weaned before discharge. There was no 30-day mortality and one in-hospital death (1.9%). Forty-six patients (87%) received multiple cycles of perioperative systemic chemotherapy. Median overall survival (OS) and disease-free survival (DFS) were 52.4 months and 18.7 months. Patents with stage 1A demonstrated a 5-year OS of 67.3% and a median DFS of 67.1 months, and patients with stage 1B-3A demonstrated a 5-year OS of 50.1% and a median DFS of 20.4 months. Univariate analysis showed histological subtype, p-T, p-stage, and multimodality treatment as significant factors affecting OS. Multivariate analysis revealed histology, p-stage, and multimodality as independent.
CONCLUSIONS
Extended P/D and HIOC with cisplatin for MPM is acceptable with limited acute kidney injury. This multimodality protocol provides promising favorable survival for stage 1A-3A disease.
PubMed: 38204668
DOI: 10.1016/j.xjon.2023.09.005 -
Journal of Thoracic Disease Jul 2023An optimal surgical procedure for primary spontaneous pneumothorax (PSP) has not yet been established. The study aimed to compare patient-reported outcomes (PROs) and...
Comparison of patient-reported outcomes and clinical outcomes between pleurectomy and pleural covering added to thoracoscopic bullectomy for primary spontaneous pneumothorax.
BACKGROUND
An optimal surgical procedure for primary spontaneous pneumothorax (PSP) has not yet been established. The study aimed to compare patient-reported outcomes (PROs) and clinical outcomes between parietal pleurectomy (pleurectomy) and visceral pleural covering with absorbable prosthesis (covering) added to thoracoscopic bullectomy in patients with PSP.
METHODS
From January 2015 to April 2018, PROs were prospectively evaluated using EuroQOL-5 dimensions-5 levels (EQ5D). Questionnaires were administered preoperatively and at 1, 3, and 5 days and 1 month postoperatively. The perioperative outcomes were compared retrospectively. Recurrences and postoperative symptoms in the distant period were investigated cross-sectionally by telephone and mail surveys in February 2020.
RESULTS
In total, 26 and 29 patients underwent covering and pleurectomy, respectively. The visual analog scale score of the EQ5D on postoperative day 1 was significantly better in the pleurectomy group than in the covering group. There was no significant difference in the frequency of PROs in the EQ5D including pain. Perioperative outcomes, such as postoperative chest tube placement, and hospital stay, were comparable between the groups, except for the operative time. There was no significant difference in the recurrence rate and frequency of residual symptoms, e.g., chest discomfort in the long-term outcomes.
CONCLUSIONS
PROs and clinical outcomes were comparable between the two procedures. Further studies are required to determine the optimal treatment procedure.
PubMed: 37559634
DOI: 10.21037/jtd-23-214 -
Journal of Clinical Medicine Jun 2022Malignant pleural mesothelioma (MPM) is an aggressive asbestos-related tumour with poor prognosis. To date, a multimodality treatment, including chemotherapy and... (Review)
Review
Malignant pleural mesothelioma (MPM) is an aggressive asbestos-related tumour with poor prognosis. To date, a multimodality treatment, including chemotherapy and surgery, with or without radiotherapy, is the gold standard therapy for selected patients with epithelioid and early-stage MPM. In this setting, the goal of surgery is to achieve the macroscopic complete resection, obtained by either extrapleural pneumonectomy or pleurectomy/decortication. Failure, in local and/or distant sites, is one of the major concerns; in fact, there has been no established treatment for the recurrence of MPM after the multimodal approach, and the role of surgery in this context is still controversial. By using electronic databases, studies that included recurrent MPM patients who underwent a second surgery were identified. The endpoints included were: a pattern of recurrence, post-recurrence survival (PRS), and the type of second surgery. When available, factors predicting better PRS and perioperative mortality and morbidity were collected. This systematic review offers an overview of the results that are currently obtained in patients undergoing a second surgery for relapsed MPM, with the aim to provide a comprehensive view on this subject that explores if a second surgery leads to an improvement in survival.
PubMed: 35743417
DOI: 10.3390/jcm11123340 -
Journal of Surgical Oncology Sep 2023Pleural metastasis has extremely poor prognosis. Resection of pleural implants with infusion of intrathoracic hyperthermic chemotherapy may offer a survival advantage in... (Review)
Review
OBJECTIVES
Pleural metastasis has extremely poor prognosis. Resection of pleural implants with infusion of intrathoracic hyperthermic chemotherapy may offer a survival advantage in selected patients. We evaluated the safety and efficacy of hyperthermic intrathoracic extracorporeal chemotherapy (HITEC) in patients who underwent pleurectomy/decortication (P/D) for secondary malignant pleural disease (SPD).
METHODS
A total of 101 patients were evaluated over 72 months, with 35 patients electing to proceed with P/D and 60 minutes of HITEC with cisplatin at 42°C. Inclusion criteria were adults 18-79 years with unilateral pleural dissemination. Exclusion criteria were patients without control of primary site, extrathoracic metastatic disease, significant comorbidities, and a history of adverse reaction to cisplatin.
RESULTS
Median age was 56 years (36-73); 60% were women. SPD was thymoma in 13, breast cancer in 9, lung cancer in 6, colon cancer in 2, renal cell in 2, and esophageal, anal, and thymic cancers in one each. There was no operative mortality. Postoperative complications occurred in 18 patients (51%). No patient developed renal failure. Median follow-up was 24 months (4-60). The overall survival rate was 61%; 17 patients (49%) developed recurrent disease at a median of 12 months (6-36). There were no recurrences after 36 months Eleven patients (31%) died of metastatic disease at a median of 17 months (7-25).
CONCLUSIONS
Surgical cytoreduction of SPD followed by HITEC with cisplatin was well tolerated. No patient developed cisplatin-related toxicities. Long-term follow-up is warranted to determine survival advantage and refinement of inclusion criteria.
Topics: Adult; Humans; Female; Middle Aged; Male; Cisplatin; Combined Modality Therapy; Pleural Neoplasms; Mesothelioma; Thymus Neoplasms; Pleural Diseases; Hyperthermia, Induced
PubMed: 37409778
DOI: 10.1002/jso.27389 -
Pakistan Journal of Medical Sciences 2020In the treatment of primary spontaneous pneumothorax (PSP), the influence of safety and applicability of uniportal video assisted thoracoscopic surgery (VATS)...
OBJECTIVE
In the treatment of primary spontaneous pneumothorax (PSP), the influence of safety and applicability of uniportal video assisted thoracoscopic surgery (VATS) bullectomy/blebectomy and pleurectomy method were evaluated in 46 patients.
METHODS
Between November 2010 and January 2019, 46 patients (36 males, 10 females; mean age 24.2 years; range 16-36 years) undergoing uniportal video thoracoscopic bullectomy/blebectomy and apical pleurectomy for primary spontaneous pneumothorax were evaluated retrospectively at Canakkale Onsekiz Mart University (COMU). One patient underwent surgery for the second time after three months for contralateral pneumothorax and counted as two different patients, hence forty seven operations were performed in total. The cases were evaluated in terms of age, gender, comorbidity, duration of hospital stay, histopathological diagnosis, postoperative morbidity and mortality.
RESULTS
Right surgical intervention was performed in 20 cases (42.6%) and left surgical intervention in 27 cases (57.6%). A total of 15 (31.9%) surgical operations were performed during the first attack, 30 (63.8%) during the second attack and 2 (4.3%) during third and more attacks. There was prolonged air leakage in all patients operated during the first episode. All cases underwent wedge resection and pleurectomy with endoscopic stapes. None of the patients required thoracotomy. Postoperative drainage period was between 2-7 days (mean: 4.1) and the duration of hospitalization was between three to eight days. Postoperative pain and paraesthesia were observed in eight cases. Prolonged air leakage was observed in five cases.
CONCLUSION
With video thoracoscopic uniportal technique, not only lung biopsy and resection but also bullectomy/blebectomy and pleurectomy operations can be performed safely in the treatment of PSP. In view of this information, minimally invasive techniques are seen as more advantageous than conventional techniques.
PubMed: 32063964
DOI: 10.12669/pjms.36.2.1556 -
The Annals of Thoracic Surgery May 2020Most patients with malignant pleural mesothelioma experience recurrence after treatment. However no clinical studies have evaluated postrecurrence survival after...
BACKGROUND
Most patients with malignant pleural mesothelioma experience recurrence after treatment. However no clinical studies have evaluated postrecurrence survival after pleurectomy/decortication for malignant pleural mesothelioma. This study aimed to clarify postrecurrence survival, treatment, prognostic factors, and recurrence pattern after pleurectomy/decortication.
METHODS
We conducted a retrospective cohort study of 90 patients who underwent neoadjuvant chemotherapy followed by pleurectomy/decortication at our hospital between September 2012 and December 2017. Survival and recurrence were calculated using the Kaplan-Meier method with the log-rank test. Clinical factors related to postrecurrence survival were assessed using multivariate analysis with the Cox proportional hazards model.
RESULTS
Of 90 patients, 57 (63.3%) developed recurrence. The 1- and 3-year recurrence-free survival rates were 69.7% and 34.0%, respectively (median recurrence-free survival time, 19.0 months). With regard to initial recurrence, 39 patients (68.4%) developed local recurrence, 6 (10.5%) developed distant recurrence, and 12 (21.1%) developed both local and distant recurrences. The 1-year postrecurrence survival rate was 59.5% (median post-recurrence survival time, 14.4 months). Forty-three patients (75.4%) underwent a postrecurrence treatment. Multivariate analysis revealed that postrecurrence treatment (hazard ratio, 0.2; 95% confidence interval, 0.07-0.55; P = .002), performance status 0 to 1 (hazard ratio, 0.24; 95% confidence interval, 0.08-0.76; P = .01), and disease-free interval more than 12 months (hazard ratio, 0.4; 95% confidence interval, 0.16-0.99; P = .04) were the independent, favorable, and significant prognostic factors of postrecurrence survival.
CONCLUSIONS
Postrecurrence survival after pleurectomy/decortication is acceptable, and postrecurrence treatment, performance status, and disease-free interval are important prognostic factors of postrecurrence survival.
Topics: Adolescent; Adult; Aged; Female; Follow-Up Studies; Humans; Incidence; Japan; Lung Neoplasms; Male; Mesothelioma; Mesothelioma, Malignant; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Pleura; Pleural Neoplasms; Positron-Emission Tomography; Retrospective Studies; Survival Rate; Tomography, X-Ray Computed; Young Adult
PubMed: 31962118
DOI: 10.1016/j.athoracsur.2019.11.048 -
Thoracic Cancer May 2024Tumor recurrence remains the main barrier to survival after surgery for pleural mesothelioma (PM). Soluble mesothelin-related protein (SMRP) and cancer antigen 125...
BACKGROUND
Tumor recurrence remains the main barrier to survival after surgery for pleural mesothelioma (PM). Soluble mesothelin-related protein (SMRP) and cancer antigen 125 (CA-125) are established blood-based biomarkers for monitoring PM. We prospectively studied the utility of these biomarkers after pleurectomy decortication (PD).
METHODS
Patients who underwent PD and achieved complete macroscopic resection with available preoperative SMRP levels were included. Tumor marker levels were determined within 60 days of three timepoints: (1) preoperation, (2) post-operation, and (3) recurrence.
RESULTS
Of 356 evaluable patients, 276 (78%) had recurrence by the end of follow-up interval. Elevated preoperative SMRP levels were associated with epithelioid histology (p < 0.013), advanced TNM (p < 0.001) stage, and clinical stage (p < 0.001). Preoperative CA-125 levels were not significantly associated with clinical covariates. Neither biomarker was associated with survival or disease-free survival. With respect to nonpleural and nonlymphatic recurrences, mean SMRP levels were elevated in patients with pleural (p = 0.021) and lymph node (p = 0.042) recurrences. CA-125 levels were significantly higher in patients with abdominal (p < 0.001) and lymph node (p = 0.004) recurrences. Among patients with all three timepoints available, we observed an average decrease in SMRP levels by 1.93 nmol/L (p < 0.001) postoperatively and again an average increase at recurrence by 0.79 nmol/L (p < 0.001). There were no significant changes in levels of CA-125 across the study timepoints (p = 0.47).
CONCLUSIONS
Longitudinal changes in SMRP levels corresponded with a radiographic presence of disease in a subset of patients. SMRP surveillance could aid in detection of local recurrences, whereas CA-125 could be helpful in recognizing abdominal recurrences.
Topics: Humans; Male; Female; CA-125 Antigen; Aged; Pleural Neoplasms; Middle Aged; Biomarkers, Tumor; Mesothelioma; Neoplasm Recurrence, Local; Mesothelin; Mesothelioma, Malignant; Prospective Studies; Adult; Aged, 80 and over; GPI-Linked Proteins; Lung Neoplasms
PubMed: 38627917
DOI: 10.1111/1759-7714.15264