The role of video assisted thoracoscopic pleurectomy/decortication in the therapeutic management of malignant pleural mesothelioma☆

Abstract

VATS decortication should be considered in the therapeutic strategy for MPM.

Efficacy and cost of video-assisted thoracoscopic partial pleurectomy versus talc pleurodesis in patients with malignant pleural mesothelioma (MesoVATS): an open-label, randomised, controlled trial

“…29 The reason for the improvement in cost-effectiveness is multifactorial. After study midpoint, trial patients undergoing VAT-PP had a slightly lower median hospital stay than did earlier patients (7 days [IQR 5-7] vs 8 days [6][7][8][9][10][11]) whereas patients with talc pleurodesis had a very similar but slightly higher median hospital stay than did earlier patients (4 days [2][3][4][5][6][7] vs 3 days [2][3][4][5]), resulting from greater use of thoracoscopy and talc poudrage in the second half of the trial (appendix), which is more expensive (talc pleurodesis cost £1129 in the first half of the trial and £2649 in the second half). Additionally, we noted some evidence of a greater difference between the groups in EQ-5D score at 6 and 12 months in the second half of the trial, whereas survival remained similar for the two groups (appendix).…”

“…6 Extrapleural pneumonectomy (EPP) has been assessed in several studies-most recently in the MARS trial 7 as part of trimodality therapy. Lung-sparing approaches, including (extended) pleurectomy with decortication [8][9][10] and video-assisted thoracoscopic partial pleurectomy (VAT-PP), have also been assessed, 11,12 and might be particularly appropriate for patients with more advanced disease or comorbidities.…”

“…6 Results of nonrandomised studies examining VAT-PP suggest that VAT-PP improved symptom control compared with EEP 11 and possibly increased survival compared with biopsy alone. 12 The standard approach to control pleural effusion in patients with malignant pleural mesothelioma is talc pleurodesis, either via a chest tube or, more recently, by thoracoscopy.…”

Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma

“…At present there is an absence of randomised trials, but a national study is ongoing in the UK which is being supported by the National Cancer Research Institute comparing VATS debulking with chemical pleurodesis (MesoVATS). There are a small series of retrospective studies which provide low-grade evidence for debulking pleurectomy [44][45][46][47]. The associated morbidity of thoracotomy may diminish the benefits [48]; however there is limited but emerging evidence that VATS can provide good symptom control and may have a beneficial effect on survival [46].…”

Pleurectomy Decortication in the Treatment of the “Trapped Lung” in Benign and Malignant Pleural Effusions

“…51,52 The technique has been extended to the visceral surface with good effect. 53 It involves a similar technique to VATS decortication of empyema but the lung parenchyma must be exposed (Figs. 4 and 5).…”