Thoracoscopic extrapleural pneumonectomy for mesothelioma

Our plain-English summary of Thoracoscopic extrapleural pneumonectomy for mesothelioma, by T.L. Demmy, I.E. Platis, C. Nwogu, et al (The Annals of Thoracic Surgery, 2011).

The study

• Authors: T.L. Demmy, I.E. Platis, C. Nwogu, S. Yendamuri
• Journal: The Annals of Thoracic Surgery
• Published: 2011;91(2):616-8
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Mesothelioma is the most common primary pleural malignancy. Surgical therapy offers limited cure benefits at the cost of high morbidity. Although technically challenging and performed rarely, a less invasive approach to extrapleural pneumonectomy was developed with the intent to speed convalescence, hasten adjuvant therapies, improve quality of life, and reduce wound surface area for possible tumor contamination.

Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This article was a surgical technique report describing one patient treated at Roswell Park Cancer Institute in Buffalo, New York. The patient was a 51-year-old man who had quit both smoking and an asbestos-associated occupation 30 years earlier. The article did not name a fiber type. He had diffuse epithelial malignant pleural mesothelioma on the right side. After two cycles of chemotherapy, on January 23, 2009, surgeons removed his right lung, pleura, pericardium and diaphragm through small thoracoscopic (keyhole) incisions instead of an open chest operation. The operation took about 7 hours until the specimen was removed, and a similar time for reconstruction. Estimated blood loss was 800 mL and no transfusion was needed. On day 7 he developed an infection (empyema), which was treated with drainage and antibiotic irrigation. He left hospital on day 30. After further chemotherapy and radiation, he had no evidence of recurrent disease one year after the operation. The authors wrote that the empyema erased any thoracoscopic benefit in this case. They concluded that this report was insufficient to advocate for thoracoscopic extrapleural pneumonectomy.

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: Surgical technique report ("How To Do It") describing a single patient (case report)
• Who was studied: One 51-year-old man with diffuse epithelial malignant pleural mesothelioma of the right side, operated on January 23, 2009, at Roswell Park Cancer Institute, Buffalo, New York
• Exposure: An asbestos-associated occupation, which he had left 30 years before presentation (fiber type and job not specified); he had also quit smoking 30 years before
• Main results:
  • The operation took about 7 hours until specimen removal, and a similar time for reconstruction. No major complications occurred during the operation.
  • Estimated blood loss for this patient was 800 mL, and no transfusion was needed.
  • No visible tumor remained after removal. The tumor had extended into the resected lung and hemidiaphragm, but the 3 perihilar lymph nodes and the bronchial and diaphragmatic margins were negative.
  • On postoperative day 7, the patient developed an infection that was treated by thoracoscopic empyema drainage. He then had 14 days of intrapleural antibiotic irrigation and was discharged on day 30.
  • After two more cycles of chemotherapy and radiation therapy (total dose 6,006 cGy in 33 fractions), the patient had no evidence of recurrent disease one year after the operation.
• The authors' conclusion: The authors concluded that this report, particularly the patient's outcome, was insufficient to advocate for thoracoscopic extrapleural pneumonectomy. They suggested that, if the procedure can be made less tedious, it may be possible to offer it to highly selected patients with favorable tumor biology.
• Limitations the authors state:
  • The empyema, possibly related to the length of the operation, erased any benefit of the thoracoscopic approach in this case.
  • The authors could not say whether patients having this operation would experience less pain.
  • It is unknown whether the extensive pleural dissection cancels out the advantage of avoiding rib spreading.

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), Mesothelioma, Quality of Life.

Related studies

• Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma — M. de Perrot, R. Feld, et al. (2016)
• 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)
• 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)
• Induction chemotherapy, extrapleural pneumonectomy, and adjuvant radiotherapy for malignant pleural mesothelioma: experience of Guy's and St Thomas' hospitals — A. Bille, E. Belcher, et al. (2012)
• Staging of patients after extrapleural pneumonectomy for malignant pleural mesothelioma--institutional review and current update — C. Cao, S.K. Krog Andvik, et al. (2011)

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