Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma: A Novel Mini-Invasive Technique

Our plain-English summary of Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma: A Novel Mini-Invasive Technique, by F.P. Caronia, A. Fiorelli, M. Santini, et al (Innovations, 2016).

The study

• Authors: F.P. Caronia, A. Fiorelli, M. Santini, E. Arrigo
• Journal: Innovations
• Published: 2016;11(6):444-447
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a novel less-invasive extrapleural pneumonectomy for early-stage malignant pleural mesothelioma without rib spreading. Our approach is unique and differed from the previously reported cases, because we used one skin incision and two small intercostal incisions with videothoracoscopic viewing without rib spreading. The pleural dissection and approach to the hilum for pneumonectomy were performed through a 4- to 5-cm port incision in the sixth intercostal space. Another 4- to 5-cm port was made in the eight intercostal space through the same skin incision and was used for diaphragm resection and reconstruction. At the end of the surgery, the skin incision was enlarged to 8 cm; through which and the first port in the sixth intercostal space, the resected specimen was retrieved. Three cycles of adjuvant chemotherapy followed by radiation therapy were administered. Eleven-month follow-up showed no recurrence.

In plain English

This article is a case report describing a surgical technique used in one patient. A 51-year-old man with left-sided epithelioid malignant pleural mesothelioma, who had already received two cycles of cisplatin/pemetrexed chemotherapy, had an extrapleural pneumonectomy. The surgeons removed the left lung, the chest lining, the left half of the diaphragm and part of the heart sac (pericardium). They used one skin incision with two small openings between the ribs, a video camera, and no rib spreading. At the end, one opening was enlarged to 8 cm to remove the tissue. The operation took 450 minutes, with an estimated 500 mL of blood lost. Pain stayed below 4 on a 0 to 10 scale, no complications occurred, and the patient went home 11 days later. He then had three cycles of chemotherapy followed by radiation, and showed no recurrence at eleven months. The article does not discuss asbestos exposure. The authors wrote that the expected benefits could not be demonstrated without a control group, that leaving the pericardium unreconstructed was a hazard, and that more data are needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report of a novel less-invasive surgical technique (one patient)
• Who was studied: one 51-year-old man with left-sided epithelioid malignant pleural mesothelioma, treated at thoracic surgery units in Italy (Catania and Naples)
• Exposure: Not reported; the article does not mention asbestos or any other exposure.
• Main results:
  • Surgical time was 450 minutes and estimated blood loss was 500 mL in this patient
  • Pain intensity score stayed below 4 on a 0 to 10 visual analogue scale throughout recovery
  • No complications during or after surgery; the patient was discharged 11 days later
  • Pathology showed epithelioid-type mesothelioma without lymph node involvement (pT2N0M0)
  • After three cycles of adjuvant chemotherapy and radiation, there was no recurrence at eleven-month follow-up
• The authors' conclusion: The authors proposed the technique as a less-invasive option for early-stage malignant pleural mesothelioma and expected it to reduce pain and morbidity, but stated that more data are needed before any conclusion can be drawn.
• Limitations the authors state:
  • The expected advantages could not be demonstrated because there was no control group
  • Not reconstructing the pericardium was a hazard because of potential life-threatening complications

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma, Hilum, Pneumonectomy, Diaphragm, Chemotherapy.

Related studies

• A new technique of diaphragmatic patch fixation in extrapleural pneumonectomy — M. Schiavon, A. De Filippis, et al. (2010)
• Extrapleural pneumonectomy in the treatment of epithelioid malignant pleural mesothelioma: novel prognostic implications of combined N1 and N2 nodal involvement based on experience in 529 patients — D.J. Sugarbaker, W.G. Richards, et al. (2014)
• Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma — M. de Perrot, R. Feld, et al. (2016)
• Extrapleural pneumonectomy for early stage malignant pleural mesothelioma: a harmful procedure — O. Rena, C. Casadio (2012)
• Clinical and pathological features of three-year survivors of malignant pleural mesothelioma following extrapleural pneumonectomy — D.J. Sugarbaker, A.S. Wolf, et al. (2011)
• Extrapleural pneumonectomy for malignant pleural mesothelioma: outcomes of treatment and prognostic factors — T.D. Yan, M. Boyer, et al. (2009)

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