Background and Objective:Pleural mesothelioma is an aggressive disease with poor prognosis due to the tendency to relapse.Despite the lack of uniform protocols of therapy,surgery remains the cornerstone of multimodal ...Background and Objective:Pleural mesothelioma is an aggressive disease with poor prognosis due to the tendency to relapse.Despite the lack of uniform protocols of therapy,surgery remains the cornerstone of multimodal treatment.Nevertheless,the debate on which is the optimal choice for surgical-based approach lasts over time and is based over the oncological benefits of obtaining a theoretical greater radicality rather than preserving the anatomical integrity in view of further treatments.This review is intended to summarize the topics of this dispute still ongoing.Methods:A review on the PubMed/Medline literature database of the different surgical approach was carried out,screening all the publications in English from 2000 to 2021.The search strategy has been focused on comparative studies of surgical techniques to understand if and how the choice of the type of surgery to be offered in the forefront has changed over the years.Key Content and Findings:Within the multimodal strategy the goal of surgery,performed with radical intent,is to achieve the macroscopic complete removal.Two procedures are aimed to this purpose:the lung-sacrificing surgery as the extrapleural pneumonectomy and the lung-sparing surgery as the pleurectomy/decortication extended or not to resection/reconstruction of diaphragm and pericardium.Many centers today have abandoned the most radical procedure in favor of the most conservative,but the superiority of one technique over the other remains controversial.Conclusions:In the absence of comparative randomized trials,the choice of surgical technique is determined by the experience of individual centers and by the attitude of surgeons.Further research is needed to standardize treatment protocols and to define the role of surgery in the context of multimodal therapy.展开更多
Malignant pleural mesothelioma(MPM)is a primary solid malignancy related to inhalational asbestos exposure.Despite advances in therapy,MPM remains challenging to treat with a post-treatment survival of only 15%at 5-ye...Malignant pleural mesothelioma(MPM)is a primary solid malignancy related to inhalational asbestos exposure.Despite advances in therapy,MPM remains challenging to treat with a post-treatment survival of only 15%at 5-year.In recent years,extra-pleural pneumonectomy has decreased in popularity due to a high morbidity rate and mortality compared to pleurectomy/decortication and other therapeutic alternatives.In this review,we will discuss both procedures,outcomes,ongoing studies,and the roles of surgery in the future treatment of this disease.展开更多
Objective: Bronchopleural fistula (BPF) is a life threatening complication after pneumonectomy. Extra thoracic skeletal muscle transposition especially latissimus dorsi muscle flap (LDMF) had been used to prevent this...Objective: Bronchopleural fistula (BPF) is a life threatening complication after pneumonectomy. Extra thoracic skeletal muscle transposition especially latissimus dorsi muscle flap (LDMF) had been used to prevent this complication. The aim of this study was to assess the effectiveness of LDMF in preventing BPF developing after extrapleural pneumonectomy (EPP) and external radiation therapy in malignant pleural mesothelioma (MPM). Methods: Between May 1999 and Dec. 2008, 37 patients with MPM were operated upon by EPP using LDMF prophylactically to reinforce the bronchial stump, and then received external radiation therapy with or without postoperative chemotherapy. Results: The mean age of all patients was 46.7 (range 26-57) years. Twenty five patients were males and 12 patients were females. Twenty three patients had MPM of the right side and 14 patients had MPM of the left side. The peri-operative mortality was 2.7% and only few flap related postoperative morbidity were reported in the form of minor seroma and subcutaneous surgical emphysema. The median follow up was 17 (range 9-43) months. All cases completed their postoperative external radiation therapy with no reported cases of early or late BPF. Conclusion: Intrathoracic pedicled LDMF transposition is proved to be effective in prevention of BPF developing after EPP and external radiation therapy in MPM and it is advised to be a routine step in EPP in these cases and to use more sophisticated technique of postoperative external beam radiotherapy (3D conformal or IMRT) to minimize this complication.展开更多
Malignant pleural mesothelioma （MPM） is a rare but rapidly deadly disease （1）. Macroscopic complete resection （MCR） is the goal of surgery （2）. MCR seems to have the most significant impact on survival in pati...Malignant pleural mesothelioma （MPM） is a rare but rapidly deadly disease （1）. Macroscopic complete resection （MCR） is the goal of surgery （2）. MCR seems to have the most significant impact on survival in patients undergoing multimodality treatment for MPM. The role of surgical resection in the management of MPM remains controversial. The selection criterion to perform either extrapleural pneumonectomy （EPP） or extended/radical pleurectomy/ decortication （PD） rely not only on the cardio-pulmonary status of the patient, tumor stage and intraoperative findings but is strongly dependent also on surgeons＇ decision and philosophy. This is reflected by a recent survey of opinions and beliefs among 802 thoracic surgeons, in which EPP was believed to be more effective than PD （3）. Nonetheless, either surgery might achieve MCR.展开更多
文摘Background and Objective:Pleural mesothelioma is an aggressive disease with poor prognosis due to the tendency to relapse.Despite the lack of uniform protocols of therapy,surgery remains the cornerstone of multimodal treatment.Nevertheless,the debate on which is the optimal choice for surgical-based approach lasts over time and is based over the oncological benefits of obtaining a theoretical greater radicality rather than preserving the anatomical integrity in view of further treatments.This review is intended to summarize the topics of this dispute still ongoing.Methods:A review on the PubMed/Medline literature database of the different surgical approach was carried out,screening all the publications in English from 2000 to 2021.The search strategy has been focused on comparative studies of surgical techniques to understand if and how the choice of the type of surgery to be offered in the forefront has changed over the years.Key Content and Findings:Within the multimodal strategy the goal of surgery,performed with radical intent,is to achieve the macroscopic complete removal.Two procedures are aimed to this purpose:the lung-sacrificing surgery as the extrapleural pneumonectomy and the lung-sparing surgery as the pleurectomy/decortication extended or not to resection/reconstruction of diaphragm and pericardium.Many centers today have abandoned the most radical procedure in favor of the most conservative,but the superiority of one technique over the other remains controversial.Conclusions:In the absence of comparative randomized trials,the choice of surgical technique is determined by the experience of individual centers and by the attitude of surgeons.Further research is needed to standardize treatment protocols and to define the role of surgery in the context of multimodal therapy.
文摘Malignant pleural mesothelioma(MPM)is a primary solid malignancy related to inhalational asbestos exposure.Despite advances in therapy,MPM remains challenging to treat with a post-treatment survival of only 15%at 5-year.In recent years,extra-pleural pneumonectomy has decreased in popularity due to a high morbidity rate and mortality compared to pleurectomy/decortication and other therapeutic alternatives.In this review,we will discuss both procedures,outcomes,ongoing studies,and the roles of surgery in the future treatment of this disease.
文摘Objective: Bronchopleural fistula (BPF) is a life threatening complication after pneumonectomy. Extra thoracic skeletal muscle transposition especially latissimus dorsi muscle flap (LDMF) had been used to prevent this complication. The aim of this study was to assess the effectiveness of LDMF in preventing BPF developing after extrapleural pneumonectomy (EPP) and external radiation therapy in malignant pleural mesothelioma (MPM). Methods: Between May 1999 and Dec. 2008, 37 patients with MPM were operated upon by EPP using LDMF prophylactically to reinforce the bronchial stump, and then received external radiation therapy with or without postoperative chemotherapy. Results: The mean age of all patients was 46.7 (range 26-57) years. Twenty five patients were males and 12 patients were females. Twenty three patients had MPM of the right side and 14 patients had MPM of the left side. The peri-operative mortality was 2.7% and only few flap related postoperative morbidity were reported in the form of minor seroma and subcutaneous surgical emphysema. The median follow up was 17 (range 9-43) months. All cases completed their postoperative external radiation therapy with no reported cases of early or late BPF. Conclusion: Intrathoracic pedicled LDMF transposition is proved to be effective in prevention of BPF developing after EPP and external radiation therapy in MPM and it is advised to be a routine step in EPP in these cases and to use more sophisticated technique of postoperative external beam radiotherapy (3D conformal or IMRT) to minimize this complication.
文摘Malignant pleural mesothelioma （MPM） is a rare but rapidly deadly disease （1）. Macroscopic complete resection （MCR） is the goal of surgery （2）. MCR seems to have the most significant impact on survival in patients undergoing multimodality treatment for MPM. The role of surgical resection in the management of MPM remains controversial. The selection criterion to perform either extrapleural pneumonectomy （EPP） or extended/radical pleurectomy/ decortication （PD） rely not only on the cardio-pulmonary status of the patient, tumor stage and intraoperative findings but is strongly dependent also on surgeons＇ decision and philosophy. This is reflected by a recent survey of opinions and beliefs among 802 thoracic surgeons, in which EPP was believed to be more effective than PD （3）. Nonetheless, either surgery might achieve MCR.
