Extrapleural Pneumonectomy and Pleurectomy in Pulmonary Tuberculosis

Sarot, Irving A.

doi:10.1136/thx.4.4.173

Cited by 67 publications

(16 citation statements)

References 14 publications

(5 reference statements)

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“…P/D, which was originally used to manage chronic empyema [1,2], has been applied to MPM in recent years. Sarot et al reported the EPP technique for tuberculous infection resistant to collapse therapy or thoracoplasty in 1949 [3]. Since Butchart et al demonstrated the utility of EPP for managing MPM patients in 1976 [4], EPP has been the standard surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

Should Lung-Sparing Surgery Be the Standard Procedure for Malignant Pleural Mesothelioma?

Ichiki

Goto

Fukuyama

et al. 2020

JCM

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Background: Surgical procedures for malignant pleural mesothelioma (MPM) include extrapleural pneumonectomy (EPP), extended pleurectomy/decortication (P/D) and P/D. EPP has been applied to MPM for a long time, but the postoperative status is extremely poor due to the loss of one whole lung. We compared the mortality, morbidity and median survival time (MST) of lung-sparing surgery (extended P/D or P/D) and lung-sacrificing surgery (EPP) for MPM by performing a systematic review. Methods: We extracted the number of events and patients from the literature identified in electronic databases. Ultimately, 15 reports were selected, and 2674 MPM patients, including 1434 patients undergoing EPP and 1240 patients undergoing extended P/D or P/D, were analyzed. Results: Our systematic review showed that lung-sparing surgery was significantly superior to lung-sacrificing surgery in both the surgical-related mortality (extended P/D vs. EPP: 3.19% vs. 7.65%, p < 0.01; P/D vs. EPP: 1.85% vs. 7.34%, p < 0.01) and morbidity (extended P/D vs. EPP: 35.7% vs. 60.0%, p < 0.01; P/D vs. EPP: 9.52% vs. 20.89%, p < 0.01). Lung-sparing surgery was not inferior to EPP in terms of MST. Conclusion: Although no prospective randomized controlled trial has been conducted, it may be time to change the standard surgical method for MPM from lung-sacrificing surgery to lung-sparing surgery.

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Section: Introductionmentioning

confidence: 99%

Should Lung-Sparing Surgery Be the Standard Procedure for Malignant Pleural Mesothelioma?

Ichiki

Goto

Fukuyama

et al. 2020

JCM

View full text Add to dashboard Cite

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“…24 When the underlying lung is too destroyed to be reexpanded to fi ll the pleural space by decortication, we may consider concomitant removal of the affected lung along with the empyema space. 25 Should CT scans demonstrate cavitary disease, large cystic bronchiectasis, or destroyed lesions in the underlying lung, reexpansion of the lung obviously cannot be anticipated. The procedure is then decortication with lobectomy or pneumonectomy (extrapleural pneumonectomy).…”

Section: Decorticationmentioning

confidence: 98%

Surgical treatment of chronic empyema

Shiraishi

2010

Gen Thorac Cardiovasc Surg

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Empyema remains challenging for thoracic surgeons. This review covers diverse aspects of acute empyema and chronic empyema and its surgical treatment. The triphasic nature of thoracic empyema (stages I, II, and III) is also addressed. The principles of empyema treatment are early diagnosis and early treatment. For acute empyema (empyema in stages I and II), early surgical intervention, such as video-assisted thoracoscopic débridement, is recommended when conventional chest tube drainage has failed. Radical treatments of chronic empyema (empyema in stage III) include (1) removal of the empyema space (decortication with or without lung resection) and (2) obliteration of the pleural space with muscle flaps or omentum flaps, or by thoracoplasty. Decortication is the procedure of choice for patients with reexpandable underlying lung. When bronchopleural fistula exists in the underlying lung, the fistula should be securely closed. For those patients whose underlying lung cannot be expected to reexpand, the procedure of choice is either concomitant removal of the affected lung with the empyema space or obliteration of the pleural space. For patients who are not eligible for the above-mentioned radical treatment, open-window thoracostomy can be considered. This procedure is not only performed as a definitive treatment of empyema but also as a preparatory treatment for radical procedures. Radical procedures are performed when patients recuperate. Choosing the most suitable operation based on the stages of empyema, the conditions of the underlying lung, and the conditions of a patient holds the key to success.

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“…While EPP had already been established for treatment refractory tuberculosis in 1949 (7), EPP for MPM was only introduced in a series of 29 patients by Butchart et al in 1976 (8). While in these patients, in-hospital mortality was as high as 31%, the safety of this procedure significantly improved over the following decades with short-term mortality ranging between 2.2% and 8.0% in recent reports (3,(9)(10)(11)(12).…”

Section: Original Articlementioning

confidence: 99%

The role of extrapleural pneumonectomy for malignant pleural mesothelioma: reviewing 20-years of experience

Werner¹,

Lauk²,

Opitz³

2020

Shanghai Chest

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Background: For patients with malignant pleural mesothelioma (MPM), a multimodality treatment concept including neoadjuvant chemotherapy and radical surgery offers improved overall survival. While the lung-sparing extended pleurectomy and decortication (EPD) has become the preferential surgical approach, the more aggressive extrapleural pneumonectomy (EPP) remains reserved for a selected group of patients.Based on our experience from the past two decades, we aim to discuss and assess today's role of EPP.Methods: Out of 523 MPM patients intended to be treated by induction chemotherapy followed by macroscopic complete resection between January 1999 and December 2019, we identified 151 consecutive patients who underwent EPP at our center. All patients were treated within a multimodality concept including neoadjuvant chemotherapy with platinum-based agents plus gemcitabine or pemetrexed. Clinical data were collected in an online database and analyzed retrospectively.Results: Of all patients, 57.6% were of IMIG stage IA or IB (n=87), 39.0% of all patients IMIG stage IIIA or IIIB (n=59). Mean tumor volume after induction chemotherapy was 294.6±315.0 cm 3 . Most patients were operated in the first decade between 1999 and 2009 [112 patients (74.2%)]. The overall 30-and 90-day mortality was 4.6% and 10.6%, respectively. The median overall survival was 18.5 months. Major postoperative morbidity was assessed as a composite outcome and occurred in 38.4% of all patients.Conclusions: Although EPD became the procedure of first choice, EPP is a reasonable approach in selected patients with high tumor burden and extensive involvement of the lung parenchyma, where parenchyma-sparing resection is technically not feasible or functionally not rational. All patients should be preoperatively assessed and informed about the eventuality of EPP, depending on intraoperative findings.

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Extrapleural Pneumonectomy and Pleurectomy in Pulmonary Tuberculosis

Cited by 67 publications

References 14 publications

Should Lung-Sparing Surgery Be the Standard Procedure for Malignant Pleural Mesothelioma?

Should Lung-Sparing Surgery Be the Standard Procedure for Malignant Pleural Mesothelioma?

Surgical treatment of chronic empyema

The role of extrapleural pneumonectomy for malignant pleural mesothelioma: reviewing 20-years of experience

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