Interactive Cardiovascular and Thoracic Surgery

Our medical research library holds 33 studies published in Interactive Cardiovascular and Thoracic Surgery (2006–2022). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 29 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it. For 2 studies PubMed has no abstract for, we give the abstract printed in the article or, where there is none, a summary we wrote from it, each labeled as such.

About the journal

• Publisher: Oxford University Press
• Published: 2002–2022, England
• Language: English
• ISSN: 1569-9293 (print), 1569-9285 (electronic)
• Continued by: Interdisciplinary Cardiovascular and Thoracic Surgery
• Its record in the NLM Catalog

2020s

• Localized malignant mesothelioma in the stomach and mediastinum. T.D. Jeppesen, A. Højsgaard, D. Kjær, et al. 2022;34(3):485-487. PubMed · Publisher · Free full text

  Abstract

  Localized malignant mesothelioma is rare. It has a histological pattern identical to diffuse malignant mesothelioma but without diffuse serosal spread. Localized malignant mesothelioma typically originates from the pleura, peritoneum or pericardium, but can occasionally develop from organs. Our cases represent what might be the largest mediastinal localized malignant mesothelioma described and the first presentation of the epithelioid type in the stomach of an adult.

  © The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

• Localized malignant pleural mesothelioma of the interlobar fissure mimicking a lung cancer. P. Ciriaco, S. Viscardi, F. Filipello, et al. 2022;34(4):700-702. Case report PubMed · Publisher · Free full text

  Abstract

  We report a case of localized malignant pleural mesothelioma (LMPM) of the interlobar fissure mimicking lung cancer. A 74-year-old woman presented with dyspnoea and a left pleural effusion. Chest computed tomography revealed a bulky mass, arising from the left lower lobe with intense uptake at the 18F-FDG PET. A left lower lobectomy was performed after thoracoscopic pleural biopsies. The final histology revealed an LMPM epithelioid like. We describe the diagnostic and curative path of the disease, speculating on the differential diagnosis and treatment of LMPM.

  © The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

• Malignant pleural mesothelioma in situ. K. Ando, T. Morohoshi, Y. Tsuura, et al. 2022;35(5). PubMed · Publisher · Free full text

  Abstract

  Although the diagnosis of malignant pleural mesothelioma at an in situ stage was traditionally challenging, it is now possible owing to advances in molecular biological methods such as P16 fluorescence in situ hybridization or BRCA1-associated protein 1 immunohistochemistry. Here, we report the first case, to our knowledge, of total parietal pleurectomy for mesothelioma in situ. Future follow-up and accumulation of cases are necessary to determine whether total parietal pleurectomy could be applied as a treatment for mesothelioma in situ or not.

  © The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

• Salvage debulking surgery and hyperthermic intrathoracic chemotherapy for massive recurrent mesothelioma in the mediastinum. S.S. Poon, C. Alberti, M. Nardini, et al. 2022;35(1). Case report PubMed · Publisher · Free full text

  Abstract

  Mediastinal malignant pleural mesothelioma with signs of tamponade is rare. Indication for reoperation for recurrent malignant pleural mesothelioma is a controversial but viable option in selected patients. We report a case of a 68-year-old man presenting with epithelioid malignant pleural mesothelioma who underwent a total of three debulking surgeries (pleurectomy/decortication) combined with hyperthermic intrathoracic chemotherapy. Five years after the first procedure, a third urgent operation was performed for recurrence of a large mediastinal mesothelioma causing acute symptoms of pericardial constriction and tamponade. The patient was alive for eight years since the first treatment and 36 months after the second reoperation.

  © The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

2010s

• Postoperative morbidity and mortality after pneumonectomy: a 30-year experience of 2064 consecutive patients. C. Pricopi, P. Mordant, C. Rivera, et al. 2015;20(3):316-21. PubMed · Publisher

  Abstract

  Objectives: We examined whether the changes in clinical practice with time correlated with the changes in the 90-day mortality following pneumonectomy.

  Methods: The clinical records of consecutive patients undergoing pneumonectomy in two French centres from 1980 to 2009 were prospectively collected. The 90-day postoperative course was retrospectively studied according to clinical characteristics, underlying diseases, type of surgery and time-period (1980-1989; 1990-1999 or 2000-2009).

  Results: Pneumonectomy was performed in 2064 patients (right n = 948, males n = 1758, mean age 60 ± 10 years). Indications were non-small-cell lung cancer (n = 1805, 87%), mesothelioma (n = 39, 1.8%), other tumours (n = 132, 6.3%) and non-tumour disease (n = 88, 4.2%). The 30- and 90-day mortality were 17.4 and 7.2% in the first decade, 22.3 and 9% in the second decade and 26.4 and 7.3% in the third decade, respectively. In multivariate analysis, older age, right-sided resection, T3-T4 and N2 lung cancer disease were significantly associated with increased overall 90-day mortality, whereas surgery during the last decade was associated with a better outcome when compared with the first decade (RR: 0.63, 95% confidence interval: 0.50-0.80, P = 0.045). When focusing on patients with non-small-cell lung cancer (NSCLC), the 90-day mortality following induction therapy and pneumonectomy decreased from 21.9% in the 1980s to 8.2% in the 2000s (P = 0.038), while such decrease was not found in patients without induction therapy or in patients undergoing a lobectomy.

  Conclusions: The overall 90-day mortality after pneumonectomy was not significantly modified over the last 30 years, while the 90-day mortality after induction therapy followed by pneumonectomy for NSCLC decreased significantly.

  © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

• Advanced malignant mesothelioma mimicking acute contained thoracic aortic rupture. N.J. Mouawad, V.C. Daniel, J.E. Starr. 2014;18(2):242-4. Case report PubMed · Publisher · Free full text

  Abstract

  In the emergent setting, patients presenting with acute interscapular pain along with haemodynamic instability require immediate evaluation. We describe the case of a patient in which computed tomographic scanning demonstrated a large hyper-dense, periaortic collection on post-contrast imaging. Urgent endovascular repair was performed for descending thoracic aortic rupture. Her postoperative course, however, was atypical with a readmission 1 week after discharge with symptoms similar to her primary presentation. Alternative pathologies were then considered in a more elective setting in which the correct diagnosis of diffuse malignant mesothelioma was ultimately discovered in a patient with no previous exposure to occupational toxins. The tumour burden was advanced and the patient opted for palliative care. Herein, we suggest a consideration for oncological thoracic pathology in patients presenting with signs and symptoms mimicking acute thoracic aortic rupture or dissection, who may demonstrate atypical symptoms.

• Localized mesothelioma tumour arising synchronously with a primary contralateral lung cancer. W. Andrews, S. Paul, N. Narula, et al. 2013;17(6):1061-2. Case report PubMed · Publisher · Free full text

  Abstract

  Mesothelioma is a malignant growth of mesothelial cells found in the serosal membrane of pleural, peritoneal and pericardial surfaces as a result of prolonged exposure to asbestos. Malignant pleural mesothelioma (MPM) typically presents itself in a diffuse pattern of growth over the pleura of the lung or in more rare cases as a localized focus (LMPM). We present the first reported case of a synchronous LMPM and non-small adenocarcinoma of the lung treated by sequential resections.

• Multimodal therapy of malignant pleural mesothelioma: is the replacement of radical surgery imminent?. J. Lindenmann, V. Matzi, N. Neuboeck, et al. 2013;16(3):237-43. PubMed · Publisher · Free full text

  Abstract

  Objectives: Malignant pleural mesothelioma (MPM) remains an aggressive thoracic malignancy associated with poor prognosis. There is no standard treatment regimen, and particularly, the impact of radical surgery remains controversial. The main goal of our retrospective single-centre study was to evaluate the surgical and non-surgical treatment modalities applied at our division regarding their effect on the patient's survival.

  Methods: During the last decade, 82 patients with histologically confirmed MPM were treated at our division. The complete clinical records of 61 patients were eligible for statistical evaluation.

  Results: There were 14 women (23%) and 47 men (77%) with a mean age of 63.7 years. Epitheloid subtype was found in 48 patients (78.7%), sarcomatoid in 3 (4.9%) and biphasic in 10 (16%). Surgery as the first treatment modality was performed in 44 patients (72.1%). Pleurectomy/decortication was done in 28 cases (45.9%), extended pleurectomy/decortication was performed in 13 (21.3%) and extrapleural pneumonectomy in 3 (4.9%). Additional intraoperative photodynamic therapy was administered in 20 patients, 34 underwent chemotherapy (55.7%) and 12 had radiotherapy (19.7%). Mean survival time for the collective was 18.3 months. Five-year survival was 17% in the epitheloid histology group, where patients treated with chemotherapy alone yielded a significant increase in survival (P = 0.049), and those with other subtypes survived for a maximum of 20.6 months.

  Conclusions: Chemotherapy and pleurectomy/decortication can extend the survival time of patients with MPM remarkably. The adequate treatment options have to be tailored to the specific particular needs of each patient considering histological subtype, tumour stage and patient's individual functional assessment as well as comorbidity.

• What is the survival after surgery for localized malignant pleural mesothelioma?. S.M. Gelvez-Zapata, D. Gaffney, M. Scarci, et al. 2013;16(4):533-7. Review PubMed · Publisher · Free full text

  Abstract

  A best evidence topic in thoracic surgery was written according to a structured protocol. This was with the purpose of assisting our management of patients with localized malignant mesothelioma of the pleura (LMM). Although the terminology is used inconsistently, this variant has been formally defined by the WHO as a distinct entity defined as localized disease histologically identical to the diffuse form but without any evidence of pleural spread. Treatments for LMM include different combinations of surgery, chemotherapy and radiotherapy. There is an impression that LMM may have a better outcome than the commoner diffuse form of malignant mesothelioma that has been reported to have a survival between 8 and 14 months. In order to advise our patients on prognosis, we studied the duration of survival after surgical resection of LMM. A total of 150 papers were found, of which 16 represented the best evidence to answer the question. The authors, journal, date, country of publication, study type, relevant outcomes and results of these papers are tabulated. It is difficult to combine the results of these 16 papers because both treatments and results are reported differently. Some report median survival (range: 11.6-36 months) and others disease-free survival (range: 0 months to 11 years). Median survival to the longest follow-up was 29 months when calculated by pooling data from informative papers using the Kaplan-Meier method. Our review suggests that survival in LMM is longer than that generally quoted for the more common diffuse form of malignant mesothelioma. Hence, aggressive treatment of LMM may be reasonable in appropriate patients.

• False aneurysm of ascending aorta due to pericardial mesothelioma. V. Uspenskiy, A. Lavreshin, A. Osadchii, et al. 2012;15(2):301-3. Case report PubMed · Publisher · Free full text

  Abstract

  Ascending aortic false aneurysm is a rare but serious complication of pericardial mesothelioma. We report a case of ascending aortic pseudoaneurysm due to spindle cell pericardial mesothelioma. In this case, the first symptoms of the disease appeared 18 months before surgery. The final diagnosis was determined only when severe late complications occurred. Palliative tumour excision, aortoplasty and aortic valve prosthesis were performed with subsequent adjuvant chemotherapy. Over 10 months after surgery, the patient is alive and a significant reduction of the tumour mass has been achieved. This case demonstrates that timely lifetime diagnosis of malignant pericardial tumour remains very difficult and effective adjuvant chemotherapy is needed to improve the results of surgery.

• Salvage therapy with topical antifungal for Aspergillus fumigatus empyema complicating extrapleural pneumonectomy. M. Purohit, A. Guleri, J. Zacharias. 2012;15(3):518-9. Case report PubMed · Publisher · Free full text

  Abstract

  We describe an unusual case of Aspergillus fumigatus empyema and bronchopleural fistulae after extrapleural pneumonectomy (EPP) and chemoradiotherapy (CRT), which was treated successfully under salvage conditions with debridement, an innovative topical antifungal application and supplemented systemic antifungal therapy and which went on for a definitive surgical procedure. Combinations of CRT and EPP have been recommended in a select group of patients with malignant mesothelioma. Irrespective of the combination, EPP is associated with mortality in the range of 4-15% and a complication rate as high as 62%.

• What is the optimum strategy for thromboembolic prophylaxis following extrapleural pneumonectomy in patients with malignant pleural mesothelioma?. A. Billè, L. Okiror, W. Karenovics, et al. 2012;15(2):201-3. PubMed · Publisher · Free full text

  Abstract

  Malignant pleural mesothelioma (MPM) increases the risk of venous thromboembolic (VTE) events. This risk is higher following extrapleural pneumonectomy (EPP) as part of trimodality therapy, where VTE can be catastrophic. In our series, the impact of warfarin in preventing a pulmonary embolus (PE) after neoadjuvant chemotherapy and EPP for MPM was analysed. A retrospective analysis of 21 consecutive patients undergoing EPP for MPM was conducted. The first 10 patients (Group A) had VTE prophylaxis by subcutaneous enoxaparin and compression stockings commenced a day prior to surgery, intraoperative pneumatic calf compression and early post-operative mobilization. Enoxaparin was continued for 30 days postoperatively. The following 11 patients (Group B) had the same VTE prophylaxis, together with warfarin, started prior to hospital discharge and continued for 6 months postoperatively. All patients had a computed tomography pulmonary angiogram within 8 weeks after surgery and a full examination at 1, 3, 6 and 12 months. Both groups were comparable for characteristics. Three patients in Group A suffered a PE at 4, 6 and 16 weeks postoperatively. One PE was fatal. No patient in Group B suffered VTE (P = 0.05, χ(2) test) or haemorrhagic complications. Warfarin anticoagulation following EPP is feasible and safe, and is associated with a significant reduction in VTE complications.

• A survey of opinions and beliefs concerning surgery for malignant pleural mesothelioma amongst 802 members of the European Association for Cardio-Thoracic Surgery (EACTS), the European Society of Thoracic Surgeons (ESTS) and the Society of Thoracic Surgeons (STS). T. Treasure, E. Internullo, F. Fiorentino, et al. 2011;12(3):341-6. Editorial PubMed · Publisher

  Summary

  The authors surveyed thoracic surgeons' opinions and beliefs about surgery for malignant pleural mesothelioma to gauge prior beliefs for planning future clinical trials. The survey was completed before the results of the MARS and EORTC 08031 trials were known. A 50-question online questionnaire was piloted among 7 members of the EACTS Thoracic Domain. Members of EACTS, ESTS and STS were then invited to complete it anonymously. It opened between 5 August and 10 September 2009 and closed on 24 November 2009. Questions covered extrapleural pneumonectomy (EPP), pleurectomy/decortication (PD) and debulking, alone or with multimodality therapy. They asked about cure, prolongation of life and improvement in breathing in epithelioid and sarcomatoid mesothelioma, and also collected demographic data. There were 802 responses, of which 235 came from ESTS members (about a quarter of its membership), 341 from EACTS members and 348 from STS members. An overall response rate could not be calculated. Surgeons believed EPP was more effective than PD, and that adjuvant and multimodality therapy increased the chance of cure. Beliefs differed little between those who did and did not perform each operation, or by type of practice or seniority. In all, 91% (637/700) believed that EPP within multimodality therapy prolongs life, and 12% (86/700) believed that PD alone can achieve cure. Answers to many questions were split about 70:30. The largest difference was geographical: 45% of US respondents believed EPP alone could cure epithelioid mesothelioma, compared with 23% in Europe. No significance tests were performed. The authors noted that this difference reflects differing North American and European guidance.

  PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

• Acute postoperative cardiac herniation. K. Kawamukai, F. Antonacci, S. Di Saverio, et al. 2011;12(1):73-4. Case report PubMed · Publisher

  Abstract

  Acute herniation of the heart is an uncommon complication in patients undergoing pneumonectomy with associated pericardial resection. We report the case of a postoperative cardiac herniation after a right extrapleural pneumonectomy following neoadjuvant chemotherapy for malignant pleural mesothelioma. After surgery the patient was completely asymptomatic, but a postoperative chest X-ray revealed unexpected massive dextrocardia. The patient was immediately brought back to the operating room: a cardiac herniation was found to be caused by a partial dehiscence of the pericardial prosthesis suture. The defect was repaired without consequences.

• Does positron emission tomography offer prognostic information in malignant pleural mesothelioma?. S. Sharif, I. Zahid, T. Routledge, et al. 2011;12(5):806-11. Review PubMed · Publisher

  Abstract

  A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether positron emission tomography is useful in the diagnosis and prognosis of malignant pleural mesothelioma (MPM). Altogether 136 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that fluorodeoxyglucose-positron emission tomography (FDG-PET) accurately differentiates benign from malignant pleural disease, helps detect recurrence and provides prognostic information in terms of staging, survival and mortality. Eleven studies evaluated the role of FDG-PET in the diagnosis and prognosis of MPM. Malignant disease had a higher standardised uptake value (SUV) (6.5 ± 3.4 vs. 0.8 ± 0.6; P < 0.001) than benign pleural disease. Shorter median survival (9.7 vs. 21 months; P = 0.02) was associated with high SUV (>10) than low SUV (<10). PET accurately upstaged 13% and downstaged 27% of cases initially staged with computed tomography (CT). In patients undergoing chemotherapy, higher total glycolytic volume led to a lower median survival (4.9 vs. 11.5 months; P = 0.09), while a decline in FDG uptake was associated with a longer time to tumour progression (14 vs. 7 months; P = 0.02). Four studies observed the role of FDG-PET-CT in the diagnosis and prognosis of MPM. SUV was found to be higher in MPM compared to benign pleural disease (6.5 vs. 0.8; P < 0.001). A higher SUV(max) was observed in primary pleural lesions of metastatic (7.1 vs. 4.7; P = 0.003) compared to non-metastatic disease. Patients who underwent surgery had equivalent survival to those excluded based on scan results (20 vs. 12 months; P = 0.3813). One study compared the utility of PET and PET-CT in the diagnosis and prognosis of mesothelioma. PET-CT was found to be more accurate than PET in terms of staging (P < 0.05) disease. Overall, PET accurately diagnoses MPM, predicts survival and disease recurrence. It can guide further management by predicting the response to chemotherapy and excluding surgery in patients with extrathoracic disease. Combined PET-CT has additional benefits in accurately staging disease.

• eComment: What is the best way to diagnose and stage malignant pleural mesothelioma?. S. Cafarotti, V. Porziella, S. Margaritora, et al. 2011;12(5):811. Comment PubMed · Publisher

• Extrapleural pneumonectomy or supportive care: treatment of malignant pleural mesothelioma?. S. Sharif, I. Zahid, T. Routledge, et al. 2011;12(6):1040-5. Review PubMed · Publisher

  Abstract

  A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether extrapleural pneumonectomy (EPP) is superior to supportive care in the treatment of patients with malignant pleural mesothelioma (MPM). Overall, 110 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that EPP confers no advantage to chemotherapy and palliative treatment in terms of survival and symptom improvement. Ten studies evaluated the role of EPP in the management of MPM. The median survival was 13 months and perioperative and 30-day mortality rates were 5.7% and 9.1%, respectively. There was a high morbidity rate of 37% including atrial fibrillation, empyema and supraventricular arrhythmias. Disease recurred in 73% of patients at a median time of 10 months. Median hospital stay was 13 days and intensive care unit stay was 1.5 days. At three months postsurgery, improvement in symptoms was achieved in 68% of patients. Significant advantages were observed in patients with epithelial MPM (19 vs. 8 months, P<0.01) compared to non-epithelial MPM and with N2 disease (19 vs. 10 months) compared to N1 or N0 disease, respectively. Two studies reported outcomes after chemotherapy in patients with MPM. The median survival was 13 months and symptoms improved in 50% of patients. Response rate of 21% was achieved and the median time to disease progression was 7.2 months. Postoperative haematological toxicity was common and included neutropenia (25%), anaemia (5%) and thrombocytopenia (7.4%). Two studies analysed palliative treatment in mesothelioma and reported a median survival of seven months and improvement in symptoms in 25% of patients at one-year post-treatment. The 30-day mortality rate was 7.8% and complications included prolonged air leak (9.8%) and empyema (4%). Median hospital stay was seven days. Overall, EPP shows no benefit in terms of survival or symptom improvement which is compounded by its high operative mortality and recurrence rate.

• Intrathoracic chemo-thermotherapy with radiofrequency waves after extrapleural pneumonectomy for malignant pleural mesothelioma. T. Tokunaga, M. Higashiyama, J. Okami, et al. 2011;13(3):267-70. PubMed · Publisher

  Abstract

  Although multimodal treatment is advocated for malignant pleural mesothelioma (MPM), a standard therapeutic regimen has not been established. This study evaluated the outcome of our aggressive treatment including extrapleural pneumonectomy (EPP) and postoperative intrathoracic chemo-thermotherapy (PICT). Moreover, we assessed the association between the clinical effect and an in vitro chemosensitivity test. Eleven patients with MPM underwent treatment including EPP followed by PICT using 8 MHz radiofrequency waves. In vitro chemosensitivity was examined using the collagen gel droplet embedded culture drug-sensitivity test (CD-DST). Complete resection was performed in nine patients. More than two courses of PICT with sufficient heating were completely performed in seven patients. There was no perioperative mortality. Grade 3 or 4 toxicity was not recognized. The median overall survival was 19 months, and the median local relapse-free survival was 17 months. Local recurrence was recognized in four patients (36.4%). Of these patients, three had received incomplete PICT. Four patients with complete PICT including a CD-DST-sensitive chemoagent did not develop local recurrence. Of three patients who received complete PICT including a CD-DST-resistant chemoagent, one tumor recurred locally. The present multimodal treatment including EPP and PICT is promising in local control for MPM. Furthermore, CD-DST may provide clinically useful information for MPM.

• Is pleurectomy and decortication superior to palliative care in the treatment of malignant pleural mesothelioma?. I. Zahid, S. Sharif, T. Routledge, et al. 2011;12(5):812-7. Review PubMed · Publisher

  Abstract

  A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether pleurectomy/decortication (P/D) is superior to palliative care in the treatment of patients with malignant pleural mesothelioma (MPM). Overall 80 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that P/D may lead to superior survival rates but at the expense of higher morbidity rates to palliative treatment. Six studies reported patient outcomes after use of radical P/D to treat patients with MPM. Radical P/D leads to a higher median survival than supportive care (14.5 vs. 4.5 months) and non-radical decortication (15.3 vs. 7.1 months, P < 0.000). However, radical P/D had a complication rate of 30%, hospital stay of 12 days with an operative mortality rate of 9.1%. One-year survival rate was 65% but this fell to 0-24% at three years. Three studies highlighted the use of palliative chemotherapy to manage patients with MPM. Median survival (14 vs. 10 months) was higher in patients who received chemotherapy early compared to those on a delayed protocol. Early chemotherapy had a longer time to disease progression (25 vs. 11 weeks, P = 0.1) and greater one-year survival (66% vs. 36%) than the delayed group. Active symptom control (ASC) alone had lower symptom control rates than the combination of ASC plus MVP (mitomycin+vinblastine+cisplatin) (7% vs. 11%, P = 0.0017) and ASC plus vinorelbine (4% vs. 7%, P = 0.047). Three studies reported results of palliative surgery in patients with known MPM. Median survival period was 213 days with a 30-day mortality rate of 7.8%. Survival rates reduced from 70.6% at three months to 25.5% at one-year post-surgery. Prolonged air-leak and postoperative empyema complicated 9.8% and 4% of patients, respectively. P/D is a morbid operation that is associated with significant perioperative mortality and complication rates. Although a number of retrospective studies have shown a small benefit in survival with P/D, the heavily documented similarity in patient outcomes between P/D and extrapleural pneumonectomy along with the results of the Mesothelioma and Radical Surgery trial, should induce the surgical community to consider the use of P/D only in patients with malignant mesothelioma enrolled in prospective trials.

• Lack of evidence in malignant pleural mesothelioma surgery. O. Rena, C. Casadio. 2011;12(3):347-8. Comment · Editorial PubMed · Publisher

  Summary

  This editorial comment discussed a published survey in which 802 thoracic surgeons from three international societies answered an online questionnaire about their opinions on surgery for malignant pleural mesothelioma (MPM). The authors noted that about half of the responders did not perform extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D), so their views came from the literature rather than personal experience. The other 352 surgeons (170 from Europe) reported performing these operations, but the authors could not obtain the crude data to judge how many operations each surgeon did. Because the disease is rare, they presumed most of these surgeons operated only occasionally. They concluded that the survey's educational value was limited and that its main value was descriptive. In their view, it showed that surgeons disagreed on the role of surgery, how extensive resection should be, and whether to combine surgery with other therapies. About 30% of responders, and about 50% in the USA, believed EPP alone could cure MPM. The authors attributed this belief to unclear use of the word 'cure'. They cited in-hospital morbidity and mortality of about 60% and 7% for EPP and about 25% and 4% for P/D. They stated that no randomised trials had shown either procedure to be more effective, and that ongoing and further randomised trials were needed.

  PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

• Malignant pleural mesothelioma: a therapeutic challenge. G. Dimitrakakis, T. BinEsmael, A. Szafranek, et al. 2011;13(6):691-2. Comment PubMed · Publisher

• Should all patients who have mesothelioma diagnosed by video-assisted thoracoscopic surgery have their intervention sites irradiated?. M. Nagendran, A. Pallis, K. Patel, et al. 2011;13(1):66-9. Systematic review PubMed · Publisher

  Abstract

  A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether patients diagnosed with mesothelioma by video-assisted thoracoscopic surgery should have their intervention sites irradiated to prevent metastatic seeding. Altogether 334 papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There is no general consensus in the literature. Four studies recommend prophylactic irradiation therapy (PIT), while three studies stated that PIT was unnecessary. A systematic review identified only three suitable randomized controlled trials (RCTs) from the literature. One trial found that 23% of radiotherapy (RT) patients developed tract metastases compared to 10% of control patients (P=0.748) with an estimated hazard ratio (RT to control) of 1.28 (95% CI: 0.29-5.73). Time from procedure to tract metastases was in fact shorter in patients treated with RT (2.4 months RT vs. 6.4 months control, non-significant). Another trial found that seeding of metastatic tumour to the intervention site occurred in 7% of RT sites vs. 10% of control sites (P=0.53). Freedom from tract metastasis survival was also non-significant between RT and control arms (P=0.82). However, the third trial reported a significantly greater incidence of intervention site metastases in control vs. RT patients (40% vs. 0%, respectively, P<0.001). Non-randomised studies found mixed results. One reported that median survival between patients with and without local metastases was not significantly different (P=0.64) while another article described no local metastases in PIT sites. None of the studies reported significant skin or side reactions and treatment was generally well tolerated. Based on the available evidence, we conclude that PIT is not currently justified.

• Staging of patients after extrapleural pneumonectomy for malignant pleural mesothelioma--institutional review and current update. C. Cao, S.K. Krog Andvik, T.D. Yan, et al. 2011;12(5):754-7. PubMed · Publisher

  Abstract

  Extrapleural pneumonectomy (EPP) has been established as a viable surgical option in the treatment of malignant pleural mesothelioma (MPM) for selected patients. A number of pathological staging systems have been developed to prognosticate survival outcomes. We assessed 91 patients with MPM who underwent EPP in our institution and evaluated the applicability of the most updated staging systems in the current literature. After a mean follow-up of 20 months, the median overall survival was 27.6 months. Postoperative pathological staging according to the International Mesothelioma Interest Group criteria (P = 0.026) and the Brigham and Women's Hospital criteria (P = 0.039) were both found to be significant prognostic factors. Adjuvant chemotherapy (P = 0.022) and radiotherapy (P = 0.008) were associated with improved survival outcomes. These findings are consistent with previous reports that demonstrated the usefulness of pathological staging systems as a prognostic tool in patients with MPM after undergoing EPP. However, preoperative clinical staging systems need to be developed to facilitate the patient selection process prior to surgery.

• Tumor extension along chest wall tract after diagnostic intervention in malignant pleural mesothelioma. F. Chen, A. Yoshizawa, K. Okubo, et al. 2011;12(6):1060-2. PubMed · Publisher

  Abstract

  To confirm the risk of chest wall tract metastases following chest wall intervention for malignant pleural mesothelioma (MPM), we reviewed our institutional experience. Between 2006 and 2010, 14 patients with MPM underwent chest wall intervention for diagnosis in Kyoto University Hospital. Seven of them underwent extrapleural pneumonectomy (EPP) after the diagnosis, while seven did not undergo EPP. All patients did not show any macroscopic abnormalities around the biopsy sites suggesting chest wall tract metastases. In the seven EPP patients, tissues including the chest wall tract, which were removed were investigated pathologically for possible metastases. In two of these seven patients, diffuse extension of MPM along the chest wall tract was pathologically confirmed. In these two patients, the period between pleural biopsy and EPP was relatively short in comparison with that in the other five patients. Despite the small number of cases, the importance of resection of the chest wall tract for the diagnostic intervention might be implied at EPP.

• Vascular endothelial growth factor in pleural fluid for differential diagnosis of benign and malignant origin and its clinical applications. A. Fiorelli, G. Vicidomini, M. Di Domenico, et al. 2011;12(3):420-4. PubMed · Publisher

  Abstract

  Our goal was to determine the role of vascular endothelial growth factor (VEGF) in diagnosing of pleural effusion (PE) in order to select patients deserving of more aggressive procedures. Seventy-nine consecutive patients with undiagnosed unilateral PE were enrolled. Pleural VEGF levels, measured using enzyme-linked immunosorbent assay (ELISA), were correlated to etiology of PEs and other markers (protein, lactic dehydrogenase, amylase, glucose). The median level of VEGF in exudates (n=65) was significantly higher than that in transudates (P=0.0001) and among exudates, it was significantly higher in malignant (n=49) than that in benign exudates (P=0.005). No significant differences were observed between malignant effusions due to lung cancer (n=11) and other malignant effusions [mesothelioma (n=13) and/or extra-thoracic cancer]. Among all variables evaluated, logistic regression found that only VEGF was significantly correlated with the presence of malignant disease (P=0.002). Analysis of the receiver operating characterists (ROC) curves showed that the areas under the curve of VEGF were significantly larger than that of amylase (P=0.02), glucose (P=0.01), lactic dehydrogenase (P=0.001) and protein (P=0.01). VEGF increased the diagnostic rate of cytological examination by 24%. VEGF may represent a helpful adjunct to conventional diagnostic tools in ruling out malignancy as a probable diagnosis, thus guiding the selection of patients who might benefit from further invasive procedures.

• What is the best way to diagnose and stage malignant pleural mesothelioma?. I. Zahid, S. Sharif, T. Routledge, et al. 2011;12(2):254-9. Review PubMed · Publisher

  Abstract

  A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was which diagnostic modality [computed tomography (CT), positron emission tomography (PET), combination PET/CT and magnetic resonance imaging (MRI)] provides the best diagnostic and staging information in patients with malignant pleural mesothelioma (MPM). Overall, 61 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that fluorodeoxyglucose (FDG)-PET is superior to MRI and CT but inferior to PET-CT, in terms of diagnostic specificity, sensitivity and staging of MPM. Four studies reported outcomes using FDG-PET to diagnose MPM. PET diagnosed MPM with high sensitivity (92%) and specificity (87.9%). Mean standardised uptake value (SUV) was higher in malignant than benign disease (4.91 vs. 1.41, P<0.0001). Lymph node metastases were detected with higher accuracy (80% vs. 66.7%) compared to extrathoracic disease. Three studies assessed the utility of PET-CT to diagnose MPM. Mean SUV was higher in malignant than benign disease (6.5 vs. 0.8, P<0.001). MPM was diagnosed with high sensitivity (88.2%), specificity (92.9%) and accuracy (88.9%). PET-CT had low sensitivity for stage N2 (38%) and T4 (67%) disease. CT-guided needle biopsy definitively diagnosed MPM after just one biopsy (100% vs. 9%) much more often than a 'blind' approach. CT had a lower success rate (92% vs. 100%) than thoracoscopic pleural biopsy but was equivalent to MRI in terms of detection of lymph node metastases (P=0.85) and visceral pleural tumour (P=0.64). CT had a lower specificity for stage II (77% vs. 100%, P<0.01) and stage III (75% vs. 100%, P<0.01) disease compared to PET-CT. Overall, the high specificity and sensitivity rates seen with open pleural biopsy make it a superior diagnostic modality to CT, MRI or PET for diagnosing patients with MPM.

• Cold-plasma coagulation in the treatment of malignant pleural mesothelioma: results of a combined approach. M. Hoffmann, H.P. Bruch, P. Kujath, et al. 2010;10(4):502-5. PubMed · Publisher

  Abstract

  Malignant pleural mesothelioma is on a continuous rise throughout the Western countries. It is associated with asbestos fibre exposition in the past. Surgical approaches include extrapleural pneumonectomy and pleurectomy/decortication (P/D). We investigated the feasability of the implementation of cold-plasma coagulation (CPC) on the pleura, pericardium and diaphragm into an established therapeutic algorithm consisting of P/D and hyperthermic intrathoracal chemoperfusion (HITHOC) therapy. The underlying rationale was the prevention of cardiotoxic effects during HITHOC as well as accidental translocation of malignant cells to the abdomen. CPC was done as part of a multimodal therapy in stage III mesothelioma patients. Histologic examinations of pleural excisates after CPC were done. The patients were followed up in three-month intervals. Neither parenchymal fistulas, nor cardiotoxic effects were observed. The histologic examination of the pleural excisates showed complete predictable necrosis. Moreover, until now (median time after operation 1 year) no relapse of the disease was observed. CPC proved to be a safe technique when used on the pleura, pericardium and diaphragm. We consider our trial as a pilot-study. To evaluate potential survival benefits using this technique larger trials are mandatory.

• Long-term results of chest wall reconstruction with DualMesh. T. Nagayasu, N. Yamasaki, T. Tagawa, et al. 2010;11(5):581-4. PubMed · Publisher

  Abstract

  The aim of this study was to evaluate the clinical outcomes of chest wall reconstruction using a new, expanded polytetrafluoroethylene prosthesis, 'DualMesh'. Between December 2005 and March 2010, chest wall reconstruction using 2-mm DualMesh was performed in 11 patients. The indication for resection was primary lung cancer in six patients, malignant mesothelioma in one patient, recurrent lung cancer in one patient, recurrent invasive thymoma in one patient, postirradiated osteomyelitis in one patient, and chondro-hamartoma in one patient. The mean observation period was 23 months, and four cases were observed for more than three years. There were no operative deaths and no wound infections. There were two postoperative complications: prolonged air leakage occurred in a patient with pulmonary emphysema who underwent right lower lobectomy, and slight paradoxical respiration occurred in the patient who underwent resection of the entire sternal body for osteomyelitis. Follow-up chest computed tomography was performed routinely. No dehiscence occurred in any cases. Chest wall reconstruction using DualMesh demonstrated acceptable durability and biocompatibility, even after long-term follow-up. DualMesh has the potential to become an ideal prosthesis for the bony chest wall as an alternative to conventional polytetrafluoroethylene or polypropylene grafts.

• Multimodality treatment of malignant pleural mesothelioma with or without immunotherapy: does it change anything?. M. Lucchi, A. Picchi, G. Alí, et al. 2010;10(4):572-6. PubMed · Publisher

  Abstract

  The purpose of this study was to investigate immunological effector cells and angiogenesis in malignant pleural mesothelioma (MPM) patients, who underwent multimodality treatments. Clinical and pathological characteristics of 57 patients, with International Mesothelioma Interest Group stage II-III MPM, who underwent two different multimodality treatments (with and without immunotherapy) between 1999 and 2008 were analyzed. CD8+, CD4+ and Foxp3+ tumor-infiltrating lymphocytes, tryptase and chymase mast cells (MCs), CD34, number of microvessels and vascular endothelial growth factor were determined by immunohistochemistry. The histology was 51 epitheliomorf and 6 biphasic. The stage was III in 41 cases and II in 16 cases. With an average follow-up of 69 months (range 9-115) 14 patients are still alive and the overall median actuarial survival is 21.4 months. Tryptase MCs, CD8+ and Foxp3+ lymphocytes had significantly increased in the interleukin 2 (IL-2) treated group. Moreover, the number of microvessels was significantly lower in IL-2 treated patients. This study indicates that immunotherapy leads to an increase in cytotoxic CD8+ lymphocytes and tryptase MCs and to a decrease of the tumoral neoangiogenesis. Changes in MPM microenvironment induced by immunotherapy may play a major role in the local control of this disease and need further investigations.

• Staging algorithm for diffuse malignant pleural mesothelioma. M. Zielinski, J. Hauer, L. Hauer, et al. 2010;10(2):185-9. PubMed · Publisher

  Abstract

  An algorithm of preoperative mediastinal nodal staging with endobronchial/endoesophageal ultrasonography (EBUS/EUS) and transcervical extended mediastinal lymphadenectomy (TEMLA) combined with laparoscopy/peritoneal lavage and cytology was analyzed to establish the realistic criteria for radical multimodality treatment of malignant pleural mesothelioma (MPM). The algorithm included computed tomography (CT), thoracoscopy with multiple pleural biopsies and talc pleurodesis, EBUS/EUS and one-stage TEMLA and laparoscopy/peritoneal lavage and cytology of the fluid. Forty-two patients were diagnosed from 1 January 2004 to 31 December 2008. There were 16 women and 26 men in ages ranging from 43 to 77 years (mean 57.8); 31 epithelioid, 2 sarcomatoid and 9 biphasic type MPM. 21/42 patients were considered possible candidates for multimodality treatment. Three patients who received neoadjuvant chemotherapy were excluded from this study. EBUS/EUS was performed to stage the mediastinal nodes. In 3/18 patients metastatic nodes were discovered. In the rest of the 15 patients simultaneous TEMLA and laparoscopy/peritoneal lavage and cytology of the fluid were performed. In three patients TEMLA was positive, in six patients laparoscopy was positive and in two patients both TEMLA and laparoscopy were positive. Finally, 4/42 (9.5%) patients underwent thoracotomy with one exploration (chest wall infiltration) and three pleuropneumonectomies with the subsequent chemo- and radiotherapy. The proposed algorithm of preoperative staging spared the majority of MPM patients from futile surgery.

2000s

• Chromosomal deletion in patients with malignant pleural mesothelioma. S. Neragi-Miandoab, D.J. Sugarbaker. 2009;9(1):42-4. PubMed · Publisher

  Abstract

  Malignant pleural mesothelioma (MPM) is associated with frequent deletions of specific chromosomal regions within 1p, 3p, 6q, 9p, 13q, 15q, and 22q. In this retrospective review of our patients with MPM, the tumor tissue of 40 patients (31 male and 9 female) was evaluated for chromosomal deletions and was karyotyped. Chromosomal deletions in regions 1p, 3p, 6p, 9p, 6q, 9q, 22q were observed in 22 of 40 patients (55%). Of this group of 22 patients, 15 (68%) demonstrated deletions in chromosome 6; 12 (54%) exhibited deletions in chromosome 22q; and 13 (59%) had deletions in chromosome 9p. Asbestos exposure was found in only 13 of the 22 patients (59%) with chromosomal deletions. There was no correlation between asbestos exposure and chromosomal deletion (95% CI -0.38-0.23, P=0.63). Chromosomal deletion did not correlate with age (95% CI -0.45-0.14, P=0.29). The majority of patients with chromosomal deletions had epithelial histology (17 of 22 patients; 77%), which was not statistically significant (95% CI -0.14-0.46, P=0.27). Chromosomal deletion is common in tumor tissue of MPM and the inactivation of tumor suppressor genes (TSGs) residing in these chromosomes may contribute to mesothelial cell tumorigenesis.

• The role of muscle flap in preventing bronchus stump insufficiency after pneumonectomy for malignant pleural mesothelioma in high-risk patients. M. Beshay, G. Carboni, B. Hoksch, et al. 2008;7(4):621-4; discussion 624-5. PubMed · Publisher

  Abstract

  Bronchus stump insufficiency (BSI) is one of the major complications after pneumonectomy; we analyzed all patients who underwent extra pleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM) in order to detect the role of muscle flap (MF) on preventing early and late stump insufficiency. From January 2000 until December 2005, there were 42 patients admitted with MPM for further intervention at our institution. Thirty patients were suitable for surgery and thus received a multimodal treatment with neo-adjuvant chemotherapy using Cisplatin and Gemcitabin (Gemzar), EPP followed by 54 Gray (Gy) adjuvant radiotherapy. Data were collected from the surgical and oncological records. There were 37 male patients (88%), the median age was 65 years (range 40-83 years). Seven (17%) patients had concomitant diseases. Forty patients (95%) had asbestos exposition. The operative procedures were EPP with muscle flap through an anterolateral thoracotomy. Univariate and multivariate analyses were done. One patient (3%) died on the 2nd postoperative day due to lung embolism. Mild complications were noticed in the early postoperative phase in 8 (25%) patients. There was no early or late stump insufficiency during the 15-month follow-up. Surgical techniques using muscle flap seems to play a major role in the prevention of bronchus stump insufficiency especially after neo-adjuvant chemotherapy.

• Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis. T. Laisaar, V. Palmiste, T. Vooder, et al. 2006;5(3):307-10. PubMed · Publisher

  Abstract

  The aim of the current study was to analyse postoperative complications and survival after video-assisted thoracoscopic (VATS) talc pleurodesis for malignant pleural effusion. All patients with morphologically proven malignant pleural effusion who underwent VATS talc pleurodesis from November 1995 to November 2002 were included in retrospective analysis. VATS was performed in general anaesthesia and 5 g of asbestos-free talc was insufflated into the pleural cavity. Postoperative pleural drainage was used until fluid output was less than 100 ml/24 h. Ninety-eight patients (28 male and 70 female) with mean age 59.6 (range 18-82) years were included. Thirteen patients had a bilateral pleural effusion. The most common primary cancer sites were lung (30 cases), breast (25) and ovarium (11). Average duration of the operation was 46 (range 10-120) min. Median duration of postoperative drainage was 3 (range 1-20) days and postoperative hospitalisation 7 (range 3-70) days. Twenty-eight patients had postoperative complications (fever in 17 cases). In seven cases pleurodesis was ineffective. Median survival was 8.4 months. Six-, 12- and 24-month survival was 58% (95% CI [0.47-0.67]), 39% [0.29-0.49] and 20% [0.12-0.29], respectively. Survival data after VATS talc pleurodesis advocate use of this invasive treatment method despite the advanced stage of cancer.

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