Commentary: A return trip to MARS: Less may be more when treating mesothelioma

Griffin, Caitlin M.; Berkel, Victor H. van

doi:10.1016/j.jtcvs.2021.07.043

Cited by 1 publication

(1 citation statement)

References 6 publications

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“…In particular, two large multicentre randomised control studies—Mesothelioma and Radical Surgery (MARS) 7 in 2011 and Mesothelioma and Radical Surgery 2 (MARS2) 26 in 2023, demonstrated no survival or quality of life benefit for patients undergoing either surgery compared with a nonsurgical chemotherapy control group. 27 Despite controversy and academic scrutiny, these radical surgeries continue to be offered in limited contexts as a potential curative option to control pleural lesions. 6 20 28 In some centres, the only indication for EPP in PM is if tumuor invades the lung and the disease is otherwise not resectable, that is, advanced disease.…”

Section: Background and Rationalementioning

confidence: 99%

Anaesthetic and perioperative considerations for extrapleural pneumonectomy and extended pleurectomy/decortication: a scoping review protocol

Yip,

Weinberg,

Gooi

et al. 2024

BMJ Open

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IntroductionExtrapleural pneumonectomy (EPP) and extended pleurectomy/decortication (ePD) are surgical cytoreductive techniques aimed at achieving macroscopic resection in malignant pleural tumours such as pleural mesothelioma, non-mesothelioma pleural malignancies such as thymoma and sarcoma, and rarely for pleural tuberculosis, in a more limited fashion. Despite extensive studies on both surgical techniques and consequences, a significant knowledge gap remains regarding how best to approach the perioperative anaesthesia challenges for EPP and ePD.It is unknown if the risk stratification processes for such surgeries are standardised or what types of functional and dynamic cardiac and pulmonary tests are employed preoperatively to assist in the perioperative risk stratification. Further, it is unknown whether the types of anaesthesia and analgesia techniques employed, and the types of haemodynamic monitoring tools used, impact on outcomes. It is also unknown whether individualised haemodynamic protocols are used to guide the rational use of fluids, vasoactive drugs and inotropes.Finally, there is a dearth of evidence regarding how best to monitor these patients postoperatively or what the most effective enhanced recovery protocols are to best mitigate postoperative complications and accelerate hospital discharge. To increase our knowledge of the perioperative and anaesthetic treatment for patients undergoing EPP/ePD, this scoping review attempts to synthesise the literature and identify these knowledge gaps.Methods and analysisThis scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review Protocols methodology. Electronic databases, OVID Medline, EMBASE and the Cochrane Library, will be systematically searched for relevant literature corresponding to EPP or ePD and perioperative or anaesthetic management. Data will be analysed and summarised descriptively and organised according to the three perioperative stages: preoperative, intraoperative and postoperative factors in clinical care.Ethics and disseminationEthics approval was not required. The findings will be disseminated through professional networks, conference presentations and publications in scientific journals.

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