Extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma

Our plain-English summary of Extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma, by D.J. Sugarbaker, S.J. Mentzer, G. Strauss (The Annals of Thoracic Surgery, 1992).

The study

• Authors: D.J. Sugarbaker, S.J. Mentzer, G. Strauss
• Journal: The Annals of Thoracic Surgery
• Published: 1992;54(5):941-6
• Cited by: 53 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A technique for extrapleural pneumonectomy in diffuse, malignant, pleural mesothelioma is described. The technique used in a protocol at Brigham and Women's Hospital has resulted in improved operative mortality figures and length of hospital stay. The right-sided procedure is presented followed by differences in technique required by the left-sided approach.

In plain English

This article described, step by step, the authors' technique for extrapleural pneumonectomy in diffuse malignant pleural mesothelioma at Brigham and Women's Hospital in Boston. The operation removed the lung, the parietal and visceral pleura, the pericardium and the diaphragm. It was part of a protocol in which surgery was followed by CAP chemotherapy (cyclophosphamide, doxorubicin and cisplatin) and radiotherapy. Resection was attempted only in Butchart clinical stage I and II patients. The right side was described first, then left-side differences. The authors reported that the principles of this technique, which had evolved over time, were used in 44 consecutive cases. Operative mortality was 4.6% (2 patients) and morbidity was 30% (13 patients). The 42 patients who survived the operation stayed in hospital a mean of 10.2 days, plus or minus 4.5. The article reported no long-term survival figures and did not discuss asbestos exposure. The authors concluded that, in a disease where five-year salvage rates of 15% to 20% would be a major advance, operative mortality must be held well below comparable levels for the operation to become a viable part of combined treatment.

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: Description of a surgical technique, with brief clinical results from a single-hospital series of consecutive cases
• Who was studied: 44 consecutive cases of pleural pneumonectomy at Brigham and Women's Hospital, Boston, in which the principles of the described technique were used. The patients had diffuse malignant pleural mesothelioma and were enrolled in a treatment protocol. Resection was attempted only in Butchart clinical stage I and II patients. The authors describe their experience as covering the previous 8 years; no exact dates are given.
• Exposure: Not an asbestos exposure study. What was studied was a treatment: extrapleural (pleural) pneumonectomy followed by CAP chemotherapy (cyclophosphamide, doxorubicin, cisplatin) and radiotherapy.
• Main results:
  • Among the 44 consecutive cases, operative mortality was 4.6% (2 patients) and morbidity was 30% (13 patients).
  • For the 42 patients who survived the operation, mean hospital stay was 10.2 days, plus or minus 4.5 days.
  • The authors stated that their surgical technique had evolved over their experience, and that their operative mortality and length of hospital stay had continued to decrease.
  • The authors reported that, in their experience, routine preoperative echocardiography and magnetic resonance imaging reduced the number of patients found at surgical exploration to be unsuitable for resection. No figures were given.
  • The authors found the procedure technically easier on the left side than on the right.
• The authors' conclusion: The authors concluded that, in a disease where five-year salvage rates of 15% to 20% would be a major advance, operative mortality must be held well below comparable levels for pleural pneumonectomy to become a viable part of a multimodality approach. They also suggested the operation may be of increasing value in achieving cytoreduction.

Topics

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

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma, Brigham and Women's Hospital.

Related studies

• 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)
• Effusion cytology after extrapleural pneumonectomy for treatment of malignant mesothelioma — A.A. Renshaw, D. Nappi, et al. (1997)
• Extrapleural pneumonectomy for malignant pleural mesothelioma: outcomes of treatment and prognostic factors — T.D. Yan, M. Boyer, et al. (2009)
• Intensity-modulated radiotherapy after extrapleural pneumonectomy in the combined-modality treatment of malignant pleural mesothelioma — A. Chi, Z. Liao, et al. (2011)
• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)
• Summary of prognostic factors and patient selection for extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma — C. Cao, T.D. Yan, et al. (2011)

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