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

Abstract

SummaryBackground Malignant pleural mesothelioma incidence continues to rise, with few available evidence-based therapeutic options. Results of previous non-randomised studies suggested that video-assisted thoracoscopic partial pleurectomy (VAT-PP) might improve symptom control and survival. We aimed to compare efficacy in terms of overall survival, and cost, of VAT-PP and talc pleurodesis in patients with malignant pleural mesothelioma.

Randomized controlled trials in malignant pleural mesothelioma surgery—mistakes made and lessons learned

“…We, therefore, undertook a randomised, controlled trial in patients with any subtype of confirmed or suspected mesothelioma with pleural effusion, recruited from 12 hospitals in the UK. Eligible patients were randomly assigned (1:1) to either video assisted thoracoscopic partial pleurectomy (VAT-PP) or talc pleurodesis, stratified by EORTC risk category (high vs. low) (14).…”

Clinical Pearls in Anaesthesia for Pleurectomy/Decortication for Malignant Mesothelioma

“…Lung carcinoma, breast carcinoma and lymphomas are the first, second and third most common cause of malignant pleural effusions [3]. Histological examination is fundamental for diagnosis and staging of mesothelioma patients.…”

“…Modern tools like video assisted thoracoscopic surgery(VATS) have led to several surgical advances. VATS is a unique less invasive alternative to traditional P/D, with potential to remove the tumor and lining of the lung [3]. Major advantage is that VATS P/D uses small incisions and a camera to visualize the chest cavity (avoiding the large posterolateral thoracotomy), leading to reduced morbidity [3].…”

“…VATS is a unique less invasive alternative to traditional P/D, with potential to remove the tumor and lining of the lung [3]. Major advantage is that VATS P/D uses small incisions and a camera to visualize the chest cavity (avoiding the large posterolateral thoracotomy), leading to reduced morbidity [3]. The latest improvement is the ventilatory strategies employed by anaesthetists to aid pleural dissection.…”

“…In pleurectomy decortication surgeries, pleural dissection can be aided by tailored lung inflation and deflation manoeuvres(by the anaesthetist) on the lung being operated [2]. Asbestos and mesothelioma are so strongly co-related that mesothelioma is considered a "signature tumor" for asbestosis [3,4], but our patient did not give a history of asbestos exposure. Rare causes of mesothelioma include chest radiotherapy, intrapleural thorium dioxide contrast, simian virus 40 infection and fibrosilicate (talc) inhalation [3,4].…”