Pleurectomy/decortication versus extrapleural pneumonectomy: a critical choice

Filosso, Pier Luigi; Guerrera, Francesco; Lausi, Paolo Olivo; Giobbe, Roberto; Lybéris, Paraskevas; Ruffini, Enrico; Oliaro, A

doi:10.21037/jtd.2018.01.116

Cited by 7 publications

(4 citation statements)

References 35 publications

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“…We therefore recommend that all patients scheduled for MCR undergo a preoperative assessment by spirometry and V/Q-scan to predict postoperative FEV1 and determine whether the healthy lung offers sufficient quality and functional reserve to tolerate an EPP (27). Our present data confirm that despite recent trends towards EPD, EPP performed in an experienced center may still offer a reasonable approach in selected cases with large tumor burden and extensive involvement of the lung parenchyma, but good functional reserve of the nonaffected lung (6,10,42,43). As a single-center study it needs to be highlighted, that external validity may be limited and the findings may not be generalizable.…”

Section: Outcomesupporting

confidence: 64%

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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Section: Outcomesupporting

confidence: 64%

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

Werner¹,

Lauk²,

Opitz³

2020

Shanghai Chest

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“…In selected patients (good performance status and early-stage disease), “radical surgical procedures” have been offered in the past, with or without different induction/adjuvant treatments [ 4 ]. In 1996, Sugarbaker et al have published a large series of MPM patients treated with extrapleural pneumonectomy (EPP) with a 5-year survival rate upper than 30% [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience

Mangiameli

Bottoni

Voulaz

et al. 2021

JCM

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Background: We analysed a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent extended Pleurectomy/Decortication (eP/D) in a centre with a high level of thoracic surgery experience (IRCCS Humanitas Research Hospital) to explore postoperative morbidity and mortality, pattern of recurrence and survival. Methods: A retrospective analysis was performed on MPM patients underwent eP/D in our centre from 2010 to 2021. All patients were identified from our departmental database. Postoperative complications were scored according to Clavien–Dindo criteria. Survival analysis was performed by the Kaplan–Meier methods and Cox multivariable analysis. Results: Eighty-five patients underwent extended pleurectomy decortication (eP/D) during study period. Macroscopical residual disease (R2) was reported in one case. A neoadjuvant chemotherapy regiment was administrated in 88% of the surgical cohort. A complete trimodality treatment including induction with platinum agents and pemetrexed, radical cytoreductive surgery and volumetric modulated arc therapy technology (VMAT) could be administered in 63 patients (74%). Postoperative morbidity rate was 54.11%, major complications (defined as Clavien–Dindo ≥ 3) were reported in 11 patients (12.9%). Thirty-day mortality and 90-day mortality were, respectively, 2.35% and 3.53%. Median disease-free and overall survival were, respectively, 13.7 and 25.5 months. The occurrence of major complications (Clavien–Dindo ≥ 3), operative time, pT3–T4, pathological node involvement (pN+) were prognostic factors associated with worse survival. Conclusions: In our experience, eP/D is a well-tolerated procedure with acceptable mortality and morbidity, allowing for the administration of trimodality regimens in most patients. eP/D offered in a multimodality treatment setting have satisfactory long term oncological results. To obtain best oncological results the goal of surgery should be macroscopic complete resection in carefully selected patients (clinical N0).

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“…While P/D spares the lung by removing only parietal and/or visceral pleura, EPP is the resection of the lung, parietal pleura, pericardium, and diaphragm. It has been reported that EPP is associated with higher perioperative mortality, lower quality of life, and lower tolerance in adjuvant chemotherapy compared to P/D [55]. However, the recurrence rate of EPP is two times lower than P/D [55], and the 5-year survival rate is not significantly different between the two [56].…”

Section: Malignant Pleural Mesotheliomamentioning

confidence: 96%

“…It has been reported that EPP is associated with higher perioperative mortality, lower quality of life, and lower tolerance in adjuvant chemotherapy compared to P/D [55]. However, the recurrence rate of EPP is two times lower than P/D [55], and the 5-year survival rate is not significantly different between the two [56]. For many years, P/D has been conducted in early stages to save the lung.…”

Section: Malignant Pleural Mesotheliomamentioning

confidence: 99%

Drug Regimen for Patients after a Pneumonectomy

Kim

Priefer

2021

JoR

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Pneumonectomy is an entire lung removal and is indicated for both malignant and benign diseases. Due to its invasiveness and postoperative complications, pneumonectomy is still associated with high mortality and morbidity. Appropriate postoperative management is crucial in pneumonectomy patients to improve quality of life and overall survival rates. Diverse drug regimens are under development to be used in adjuvant chemotherapy or to improve respiratory health after a pneumonectomy. The most common causes for a pneumonectomy are non-small cell lung cancer, malignant pleural mesothelioma, and tuberculosis; thus, an appropriate drug regimen is necessary. The uncommon incidence of pneumonectomy cases remains the major obstacle in studies of postoperative drug regimens. As the majority of current studies include post-lobectomy and post-segmentectomy patients, it is highly recommended that further research of postoperative drug regimens be focused on post-pneumonectomy patients.

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Pleurectomy/decortication versus extrapleural pneumonectomy: a critical choice

Cited by 7 publications

References 35 publications

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

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

Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience

Drug Regimen for Patients after a Pneumonectomy

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