Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience

Ried, Michael; Potzger, T; Braune, N.; Neu, Reiner; Zausig, York; Schalke, Berthold; Diez, Claudius; Hofmann, Hans‐Stefan

doi:10.1093/ejcts/ezs418

Cited by 92 publications

(57 citation statements)

References 23 publications

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“…Hyperthermic intraoperative intrathoracic chemoperfusion has been performed after debulking surgery for MPM, lung cancer, thymoma and recurrent ovarian cancer with satisfactory results [7,[13][14][15][16][17]. Our initial experience includes eight patients, of those six with MPM, and two with adenocarcinoma of the lung.…”

Section: Discussionmentioning

confidence: 99%

Cytoreductive Surgery and Hyperthermic Intrapleural Chemotherapy for Malignant Pleural Diseases: Preliminary Experience

et al. 2015

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Cytoreductive surgery and hyperthermic-intraoperative-intrapleural-chemotherapy (HITHOC) is a known approach for malignant pleural diseases (MPD). This study was started to clarify the role of cytoreductive surgery and HITHOC in MPD. Criteria of inclusion were early-stage disease in malignant pleural mesothelioma (MPM), young age, good condition and selected stage-M1a lung cancer. Six patients with MPM and two patients with lung cancer were enrolled. After surgical debulking, intrapleural cisplatin was administered for 60 min at 42.5°C. Wedge, rib resection and repaired diaphragm were added in three, one and one patient, respectively. Morbidity, toxicity and mortality was nil. Hospital stay was 8 days. Mean survival is 13.6 months. This experience confirms that cytoreductive surgery and HITHOC is a good option in the treatment of MPD. A randomized controlled trial is necessary.

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Section: Discussionmentioning

confidence: 99%

Cytoreductive Surgery and Hyperthermic Intrapleural Chemotherapy for Malignant Pleural Diseases: Preliminary Experience

et al. 2015

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“…The ethics committee of the University of Regensburg approved the study protocol. An article describing the surgical procedure of this clinical trial has already been published [6]. To protect confidentiality, all data have been anonymised.…”

Section: Methodsmentioning

confidence: 99%

“…Recently a new multimodal treatment approach, including radio-, chemotherapy and macroscopic complete cytoreductive surgery (pleurectomy/decortication or extrapleural pneumonectomy) combined with HITHOC is available, which must be analysed as a potential curative treatment strategy in the upcoming years [1-3]. According to the success of cytoreductive surgery and intraperitoneal hyperthermic perfusion chemotherapy (HIPEC) for peritoneal malignancies [4], results of first studies are promising reaching a decreased recurrence rate and an improved long-term survival [5,6]. Although in the meantime the intra- and postoperative morbidity and mortality depending on patient’s disorders, intraoperative cytostatic concentrations [7] and the degree of surgical resection [8] could be reduced, cytoreductive surgery and HITHOC is a real challenge for the anaesthesiologist with respect to intraoperative management and postoperative pain therapy.…”

Section: Introductionmentioning

confidence: 99%

Anaesthetic management of cytoreductive surgery followed by hyperthermic intrathoracic chemotherapy perfusion

Kerscher

Ried

Hofmann

et al. 2014

J Cardiothorac Surg

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BackgroundMacroscopic cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion (HITHOC) is a new multimodal approach for selected patients with primary and secondary pleural tumors, which may provide the patient with better local tumor control and increased overall survival rate.MethodsWe present a single-center study including 20 patients undergoing cytoreductive surgery and HITHOC between September 2008 and April 2013 at the University Medical Center Regensburg, Germany. Objective of the study was to describe the perioperative, anaesthetic management with special respect to pain and complication management.ResultsAnaesthesia during this procedure is characterized by increased intrathoracic airway and central venous pressure, hemodynamic alterations and the risk of systemic hypo- and hyperthermia. Securing an adequate intravascular volume is one of the primary goals to prevent decreased cardiac output as well as pulmonary edema. Transfusion of packed red blood cells (PRBC) was necessary in seven of 20 (35%) patients. Only two patients (10%) showed an impairment of coagulation in postoperative laboratory analysis. Perioperative forced diuresis is recommended to prevent postoperative renal insufficiency. Supplementary thoracic epidural analgesia in 13 patients (65%) showed a significant reduction of post-operative pain compared with peroral administration of opioid and non-opioid analgesics.ConclusionThis article summarizes important experiences of the anaesthesiological and intensive care management in patients undergoing HITHOC.

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“…In recent times, surgery is also merged with hyperthermic intrathoracic chemotherapy to attain microscopic tumour control and improved survival. 4 Thoracic epidural catheter is commonly placed to minimize risk of pulmonary dysfunction related to the large surgical incision and to facilitate early post-operative recovery as seen in our patient. Large bore intravenous access is established, and blood products should be available in operating theatre given the potential risk of significant blood loss.…”

Section: Discussionmentioning

confidence: 99%

Extrapleural pneumonectomy- perioperative anaesthetic conduct

Tsai

Liu

Shah

2018

Sri Lankan J Anaesthesiol

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Malignant mesothelioma is a rare tumour arising from mesothelial lining that mostly occurs in the pleura with survival of around 12 months.1 Extrapleural pneumonectomy, which is the mainstay of treatment for locally advanced malignant pleural mesothelioma, presents a great challenge to anaesthesiologists as it can be associated with high perioperative morbidity and mortality. We present a case report on anaesthetic management for extrapleural pneumonectomy in a 64-year-old patient with advanced malignant pleura mesothelioma. Our case report highlights: crucial role of anaesthetic management in reducing perioperative complications by better knowledge of physiology and technical aspects of the surgery; issues and challenges related to the anaesthetic management such as invasive monitoring, lung isolation, protective lung ventilation strategy, appropriate fluid management and adequate analgesia to enable extubation post-surgery in the operating room; high vigilance for diagnosing life-threatening complications such as cardiac herniation; team working and collaboration with surgeon to improve patient outcome and post-operative monitoring and management.

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Cytoreductive surgery and hyperthermic intrathoracic chemotherapy perfusion for malignant pleural tumours: perioperative management and clinical experience

Cited by 92 publications

References 23 publications

Cytoreductive Surgery and Hyperthermic Intrapleural Chemotherapy for Malignant Pleural Diseases: Preliminary Experience

Cytoreductive Surgery and Hyperthermic Intrapleural Chemotherapy for Malignant Pleural Diseases: Preliminary Experience

Anaesthetic management of cytoreductive surgery followed by hyperthermic intrathoracic chemotherapy perfusion

Extrapleural pneumonectomy- perioperative anaesthetic conduct

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