The new case for cervical mediastinoscopy in selection for radical surgery for malignant pleural mesothelioma

Nakas, Apostolos; Waller, David; Lau, Kelvin; Richards, Cathy; Muller, S.

doi:10.1093/ejcts/ezr251

Cited by 24 publications

(16 citation statements)

References 11 publications

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“…It may also be used in the diagnosis of MPM, particularly in the so-called "dry" presentation of the disease [24,25]. Conversely, patients with extra-pleural and extra-mediastinal node involvement (not reachable either by mediastinoscopy nor EUS/EBUS) were found to have a better prognosis, supporting the importance of mediastinoscopy [26].…”

Section: Surgery For Stagingmentioning

confidence: 98%

The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence

Bertoglio

Waller

2016

Expert Review of Respiratory Medicine

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Surgery has a key role at different points in the management of Malignant Pleural Mesothelioma. Diagnosis with video assisted thoracoscopy offers excellent sensitivity and specificity and a direct view of the pleural cavity to verify the extent of the tumor. Nodal involvement can be assessed by mediastinoscopy and either talc pleurodesis or partial pleurectomy can be used for symptom control in advanced stage disease. Extra Pleural Pneumonectomy (EPP) and Extended Pleurectomy Decortication (EPD) are used to prolong survival although the benefit of radical surgery has not has been fully clarified; EPP failed to show its benefit in the MARS trial and EPD is currently under investigation in the MARS2 trial. More randomized prospective trial data are needed to fully understand the role of radical surgery in the treatment of pleural mesothelioma.

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Section: Surgery For Stagingmentioning

confidence: 98%

The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence

Bertoglio

Waller

2016

Expert Review of Respiratory Medicine

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“…A literature review evaluating reports in the last 10 years of outcomes after pleurectomy decortication demonstrates a median survival between 10 and 25 months (Table 1) (2,5,9,12,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Thirty-day mortality was between 0.0-6.8% across all studies.…”

Section: Discussionmentioning

confidence: 98%

Pleurectomy and decortication

Vlahu

Vigneswaran

2017

Ann. Transl. Med.

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Pleurectomy and decortication (P/D) improve survival and quality of life in selected patients with malignant pleural mesothelioma. The operative procedure was not standardized until recently. The goal of the operation is to perform a macroscopic complete resection of the tumor. This often involves resection of the parietal and visceral pleura and invariably a partial or complete resection and prosthetic reconstruction of ipsilateral hemidiaphragm. We describe our operative planning and technique as well as outcomes of P/D reported in current literature.

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“…The presence of metastatic disease in extrapleural (N2) nodes increases stage, predicts poorer outcome, and should prompt referral for chemotherapy [21,22]. Presently, the role of endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS) for mediastinal staging is unclear and needs further investigation before supplanting cervical mediastinoscopy [23]. However, there are some reports of successful staging with these tools [24,25].…”

Section: Absolutementioning

confidence: 99%

“…In mixed cohorts of patients undergoing EPP or PD/EPD, epithelial histology, early stage disease, as well as nodal status continue to predict survival in the setting of multimodality treatment reiterating the importance of preoperative mediastinoscopy and radiographic staging regardless of surgical procedure performed [3,23].…”

Section: • • Pleurectomy/decorticationmentioning

confidence: 99%

Surgery for malignant pleural mesothelioma

Archer

Bueno

2015

Lung Cancer Management

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Malignant pleural mesothelioma is a locally aggressive asbestos-related cancer that has a worldwide distribution and an overall poor prognosis. The average median survival for patients receiving the current best nonsurgical therapy, cisplatin/pemetrexed chemotherapy, is between 7 and 13 months. In selected patients with early stage disease and favorable tumor characteristics, aggressive surgical management in combination with adjuvant or neoadjuvant therapy extends survival in up to 20% of patients. Despite the benefits of surgery for mesothelioma, many patients are not suitable for operative intervention due to advanced stage disease at presentation or the inability to tolerate aggressive surgical resection. The frontiers of mesothelioma research and treatment include an urgent search for biomarkers that can reliably detect early stage cancer in at-risk populations, clinical tests or indices that can reliably predict prognosis among surgical candidates and the development of efficacious drugs and targeted therapies that offer more durable local disease control.

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The new case for cervical mediastinoscopy in selection for radical surgery for malignant pleural mesothelioma

Abstract: There is a strong case for routine CM as a method of prognostic staging in all patients undergoing radical surgery for MPM. The addition of EUS staging and the detection of nodal metastases inaccessible to mediastinoscopy had no prognostic benefit.

Cited by 24 publications

References 11 publications

The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence

The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence

Pleurectomy and decortication

Surgery for malignant pleural mesothelioma

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