Pleurectomy decortication in the treatment of the "trapped lung" in benign and malignant pleural effusions

Our plain-English summary of Pleurectomy decortication in the treatment of the "trapped lung" in benign and malignant pleural effusions, by S. Rathinam, D.A. Waller (Thoracic Surgery Clinics, 2013).

The study

• Authors: S. Rathinam, D.A. Waller
• Journal: Thoracic Surgery Clinics
• Published: 2013;23(1):51-61, vi
• Type of article: Review
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Trapped lung is defined by the inability of the lung to expand and fill the thoracic cavity because of a restricting "peel." This restriction may be secondary to a benign inflammatory or fibrotic cortex or to a malignant visceral pleural tumor. This condition has a significant impact on the patient's quality of life by causing dyspnea. This article discusses the role of surgery in relieving the trapped lung, including decortication in benign disease and pleurectomy in malignant disease. The surgical approaches of video-assisted thoracoscopy and thoracotomy are contrasted and the future potential for surgical trials in this condition is outlined.

Copyright © 2013 Elsevier Inc. All rights reserved.

In plain English

This was a narrative review by UK surgeons on surgery for "trapped lung": a lung that cannot re-expand because a restricting peel covers it. The peel may come from benign disease such as empyema (pus in the chest cavity) or from tumor, most commonly malignant pleural mesothelioma or cancer spread to the pleura. The article reported no new patient data and did not discuss asbestos. It described decortication for benign disease and pleurectomy for malignant disease, and compared keyhole surgery (VATS) with open surgery. In one cited series of 79 patients with advanced mesothelioma, actuarial survival was 416 days after VATS pleurectomy decortication versus 127 days after VATS biopsy. The authors concluded that decortication can be safely achieved by VATS and that early intervention gives the best results in benign disease. For malignant trapped lung, they named VATS visceral pleurectomy or open extended pleurectomy decortication as the two options. However, they called VATS visceral pleurectomy debatable in metastatic disease, where PleurX catheters might be better. They noted that a UK trial, MesoVATS, excluded patients with trapped lung.

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: Narrative review of surgical management of trapped lung (no original patient data; no search method described)
• Who was studied: No patients were studied directly. The authors reviewed published studies on benign and malignant trapped lung. These included a table of five UK cohort series (1995 to 2008) of patients with malignant effusion, mostly malignant pleural mesothelioma. Four series had 19, 25, 51 and 79 patients; the fifth analysed 63 of 208 patients.
• Exposure: Not an exposure study. The article does not discuss asbestos or fiber types. Its topic is surgical treatment: decortication, pleurectomy, and VATS versus thoracotomy.
• Main results:
  • Cited series (Halstead et al, 2005) of 79 patients with advanced MPM: actuarial survival was 127 days in the VATS biopsy group (28 patients) versus 416 days in the VATS pleurectomy decortication group (51 patients), P<0.001.
  • Cited series (Martin-Ucar et al, 2001) of 51 patients with advanced MPM: survival was 89% at 6 weeks, 71% at 3 months, 56% at 6 months and 31% at 12 months.
  • Benign disease (cited studies): releasing the trapped lung in chronic empyema improved forced vital capacity from 61% up to 77% and FEV1 from 61% to 78%.
  • Cited study of VATS decortication: postoperative length of stay was 9.1 days for stage 2 disease (145 patients) versus 18.5 days for stage 3 (89 patients), P<0.05.
  • Cited studies comparing VATS with open decortication reported shorter operative time with VATS (2.5 vs 3.8 hours; P<0.001).
  • For malignant trapped lung, the authors described two options: VATS visceral pleurectomy, for relief of breathlessness and possible survival benefit, or open extended pleurectomy decortication (EPD).
  • The authors called it debatable whether VATS visceral pleurectomy is indicated in metastatic disease, where prognosis is poor. They wrote that placing PleurX catheters might be a better option there.
• The authors' conclusion: The authors concluded that decortication can be safely achieved by VATS and that early thoracoscopic intervention for benign effusions and empyemas offers the best results.
• Limitations the authors state:
  • The UK MesoVATS trial excluded patients with trapped lung, and its results were still awaited.
  • Further research is needed on the role of visceral pleural decortication in malignant pleural mesothelioma.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Trapped Lung, Pleural Effusion, Quality of Life, Dyspnea, Thoracoscopy, Thoracotomy.

Related studies

• MesoTRAP: a feasibility study that includes a pilot clinical trial comparing video-assisted thoracoscopic partial pleurectomy decortication with indwelling pleural catheter in patients with trapped lung due to malignant pleural mesothelioma designed to address recruitment and randomisation uncertainties and sample size requirements for a phase III trial — C. Matthews, C. Freeman, et al. (2019)
• Symptomatic benign pleural effusions among asbestos insulation workers: residual radiographic abnormalities — R. Lilis, Y. Lerman, et al. (1988)
• Pleural irregularities and mediastinal pleural involvement in early stages of malignant pleural mesothelioma and benign asbestos pleural effusion — K. Kato, K. Gemba, et al. (2016)
• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)
• High dose irradiation after pleurectomy/decortication or biopsy for pleural mesothelioma treatment — E. Parisi, A. Romeo, et al. (2017)
• Is it time to consider pleurectomy and decortication as the only surgical treatment for malignant pleural mesothelioma? — M.J. Weyant (2012)

Browse more research in Thoracic Surgery Clinics, or return to medical research.