The role of muscle flap in preventing bronchus stump insufficiency after pneumonectomy for malignant pleural mesothelioma in high-risk patients

Our plain-English summary of The role of muscle flap in preventing bronchus stump insufficiency after pneumonectomy for malignant pleural mesothelioma in high-risk patients, by M. Beshay, G. Carboni, B. Hoksch, et al (Interactive Cardiovascular and Thoracic Surgery, 2008).

The study

• Authors: M. Beshay, G. Carboni, B. Hoksch, M.A. Reymond, R.A. Schmid
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2008;7(4):621-4; discussion 624-5
• Cited by: 5 articles, as counted by NIH iCite
• Read it: 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.

In plain English

This retrospective report from one surgical department described patients with malignant pleural mesothelioma treated with extrapleural pneumonectomy, an operation removing the affected lung. Of 42 patients admitted between January 2000 and December 2005, 40 (95%) had occupational asbestos exposure. The article did not report fiber types or jobs. Thirty were judged suitable for surgery and received three cycles of chemotherapy beforehand. All 30 had the bronchus stump (the closed end of the airway) covered with a muscle flap: latissimus dorsi in 28, serratus anterior in 2. Every operated patient received a flap, so there was no comparison group of operated patients without one. The authors reported no early or late stump insufficiency during the 15-month follow-up. One patient (3%) died on the second postoperative day from a massive lung embolism. Eight (27%) had mild complications, and 18 (60%) received blood transfusions. Eight patients (27%) had local recurrence at the 6- and 12-month follow-ups, and overall survival over 12 months was 62%. The authors proposed the muscle flap as effective in high-risk patients and said further studies were 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: retrospective single-institution case series (institutional report) of patients admitted with malignant pleural mesothelioma; every operated patient received a muscle flap over the bronchus stump, with no operated comparison group without a flap
• Who was studied: 42 patients admitted with malignant pleural mesothelioma at the authors' institution from January 2000 to December 2005 (37 male, median age 65); 30 of them underwent surgery and 12 were excluded from surgery
• Exposure: Asbestos exposure was a patient characteristic, not the focus of the study. 40 of 42 patients (95%) had occupational asbestos exposure. Of the other two, one had family exposure to asbestos. Fiber types and jobs were not reported. The study itself examined a surgical technique: a muscle flap covering the bronchus stump.
• Main results:
  • 30 of 42 patients (71%) were suitable for surgery and received three cycles of preoperative chemotherapy with cisplatin and gemcitabin
  • Twelve admitted patients (29%) were excluded from surgery
  • A muscle flap was used to cover the bronchus stump in all operated patients
  • Among the 30 operated patients, the bronchus stump was covered with a latissimus dorsi muscle flap in 28 and with four strips of serratus anterior muscle in 2
  • No early or late bronchus stump insufficiency occurred among the operated patients during the 15-month follow-up
  • One operated patient (3%) died on the 2nd postoperative day from massive lung embolism
  • Mild early postoperative complications occurred in eight operated patients (27%): atrial fibrillation (4), low potassium (2), wound seroma needing drainage (1) and urinary tract infection (1)
  • Eighteen operated patients (60%) received 2 to 6 bottles of blood transfusion
  • The operation took 50 minutes longer than a usual pneumonectomy (mean 148 minutes; p value 0.031)
  • At the 6- and 12-month follow-ups, local recurrence was found in eight operated patients (27%)
  • Overall survival over the 12-month follow-up period was 62%
• The authors' conclusion: The authors proposed that covering the bronchus stump with a muscle flap is an effective method to prevent stump insufficiency after pneumonectomy, especially in high-risk patients
• Limitations the authors state:
  • The authors stated that further studies are needed to confirm their observations
  • In the conference discussion, the presenting author said the follow-up was short, covering only the last 15 months

Topics

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

Medical terms in this study, explained in our Lexicon: Bronchus, Pneumonectomy, Pleural Mesothelioma, Chemotherapy, Cisplatin, Thoracotomy.

Related studies

• A comparative evaluation of intrathoracic latissimus dorsi and serratus anterior muscle transposition — M.K. Widmer, T. Krueger, et al. (2000)
• Impact of induction therapy on postoperative outcome after extrapleural pneumonectomy for malignant pleural mesothelioma: does induction-accelerated hemithoracic radiation increase the surgical risk? — P. Mordant, K. McRae, et al. (2016)
• Amplatzer Device in Bronchial Stump Fistula after Extrapleural Pneumonectomy — J. Turtiainen, J.V. Räsänen, et al. (2016)
• Staging of patients after extrapleural pneumonectomy for malignant pleural mesothelioma--institutional review and current update — C. Cao, S.K. Krog Andvik, et al. (2011)
• Extrapleural pneumonectomy after induction chemotherapy: perioperative outcome in 251 mesothelioma patients from three high-volume institutions — O. Lauk, M.A. Hoda, et al. (2014)
• Trimodality strategy for treating malignant pleural mesothelioma: results of a feasibility study of induction pemetrexed plus cisplatin followed by extrapleural pneumonectomy and postoperative hemithoracic radiation (Japan Mesothelioma Interest Group 0601 Trial) — S. Hasegawa, M. Okada, et al. (2016)

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