Complications and Predictive Factors for Air Leak &gt; 10 Days with Neoadjuvant Chemotherapy Followed by Pleurectomy/Decortication for Malignant Pleural Mesothelioma

Nakamura, Akifumi; Kondo, Nobuyuki; Nakamichi, Toru; Hashimoto, Masaki; Takuwa, Teruhisa; Matsumoto, Seiji; Kuribayashi, Kozo; Kijima, Takashi; Hasegawa, Seiki

doi:10.1245/s10434-020-09275-y

Cited by 13 publications

(10 citation statements)

References 38 publications

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“…Only 2 studies have investigated the prognostic value of PNI in malignant pleural mesothelioma (MPM) (10,11), with both concluding that low PNI is a risk factor for worse OS. PNI was found to be associated with age, smoking, and weight loss (11).…”

Section: Other Respiratory System Neoplasmsmentioning

confidence: 99%

Long-term and short-term prognostic value of the prognostic nutritional index in cancer: a narrative review

Li¹,

Nakamura²,

Casadei-Gardini³

et al. 2021

Ann Transl Med

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Objective: To perform a narrative review of the prognostic value of prognostic nutritional index (PNI) in cancers.Background: Prognostic estimation greatly determines the treatment approach in various cancers. The prognostic nutritional index (PNI), calculated using the serum albumin level and total lymphocyte count, is a useful indicator to assess nutritional and immunological conditions. The PNI represents a low-cost, easy-toperform, noninvasive, rapid, and standardized tool for estimating the prognosis of cancer. Many studies have aimed to clarify the prognostic value of PNI for various types of cancer. Methods:We summarize the studies, particularly the systematic reviews and meta-analyses, that have examined the prognostic value of PNI in common cancers. Conclusions:The relevant studies indicate that low PNI is an independent prognostic factor for decreasing overall survival in many types of cancers. Disease-free survival and progression-free survival were also associated with PNI in some types of cancer including lung cancer and renal cell carcinoma. Therefore, we suggest that the measurement of PNI is a useful method to identify cancer patients that have a worse prognosis and that the treatment strategy for these patients be adjusted accordingly. We hypothesize that maintaining good nutritional status during treatment may improve outcomes of various cancers.

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Section: Other Respiratory System Neoplasmsmentioning

confidence: 99%

Long-term and short-term prognostic value of the prognostic nutritional index in cancer: a narrative review

Li¹,

Nakamura²,

Casadei-Gardini³

et al. 2021

Ann Transl Med

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“…In our experience, talc poudrage has more probability to succeed when the visceral pleura is not too thickened, thus at the earliest times of most MPM development. Except in the few patients eligible for multimodal treatment including pleurectomy-decortication, in whom it could make the dissection more complex and favor the associated complications [ 12 ], first-intent pleural symphysis is probably preferential. Indeed, it avoids repeated pleurocenteses or indwelling catheter insertion both requiring dedicated management and complicating with adverse-events such as chronic pain or device infection [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical Diagnosis of Malignant Pleural Mesothelioma: 20 Years’ Experience at a High-Volume Referral Center

Iaffaldano

Charrier

Lococo

et al. 2021

JCM

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Despite advances, malignant pleural mesothelioma (MPM) remains a challenging disease in terms of diagnosis, treatment, and overall management. Herein, we analyzed, in a large-scale single-center cohort, the characteristics and perioperative course of patients undergoing surgical diagnosis of MPM. We identified a total of 514 consecutive patients, 71.4% male and 28.6% female, with mean age 71.3 +/− 13.6 years. Most exhibited pleural, respiratory, or general symptoms and American Society of Anesthesiologists (ASA) score was ≥3 in 68.3% of cases. Thoracoscopy was the most frequent approach (92.0%) and short open thoracotomy was performed in the remaining patients. Pleurodesis was simultaneously performed in 74.3% of cases. Diagnostic failure led to redo surgery in 3.7% of patients. Non-epithelioid histology was found in 19.5% of MPMs and was significantly more frequent in right-sided MPM (p = 0.04), and in patients without history of cancer (p = 0.03), or pleural nodules at thoracoscopy (p = 0.01). Minor only or major complications occurred in respectively 7.8% and 3.6% of cases. They were more frequent in patients ≥ 70 years (p = 0.05) and Performance Status > 2 (p = 0.05). The mean hospital stay was 7.5 days. The 30-day and 90-day early mortality rates were 2.3% and 6.4%, respectively. Surgical diagnosis of MPM is a reliable procedure but is associated with significant morbidity and hospital-stay duration.

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“…Since the perioperative morbidity and mortality folllowing P/D are lower than those with EPP, P/D has recently been preferred over EPP as the first-choice surgical procedure 3–5. The incidence of major complications within 30 days after surgery, however, is still high even after P/D (13%–51%),4–7 corresponding to that after EPP (27%–45%) 5 6 8. Our previous study, however, reported that no risk factor for postoperative complications was observed in perioperative variables in P/D 5…”

Section: Introductionmentioning

confidence: 90%

“…Malignant pleural mesothelioma (MPM) is a rare malignancy usually related to asbestos exposure, that is associated with a poor prognosis 1–3. Both extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are usually performed as a part of multimodal treatment for MPM, as surgical procedures with curative intent 1–5. EPP, which was traditionally the surgical technique of choice, consists of en bloc resection of the lung, pleura, pericardium and diaphragm.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, P/D is a less invasive procedure than EPP. Since the perioperative morbidity and mortality folllowing P/D are lower than those with EPP, P/D has recently been preferred over EPP as the first-choice surgical procedure 3–5. The incidence of major complications within 30 days after surgery, however, is still high even after P/D (13%–51%),4–7 corresponding to that after EPP (27%–45%) 5 6 8.…”

Section: Introductionmentioning

confidence: 99%

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Association between thoracic epidural block and major complications after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia

Onoe¹,

Ogata²,

Okamoto³

et al. 2022

Reg Anesth Pain Med

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IntroductionA curative-intent surgical procedure, pleurectomy/decortication, for malignant pleural mesothelioma is accompanied by a high incidence of major postoperative complications. Although epidural block, which suppresses nociception during and after surgery, reportedly has both benefits and disadvantages in terms of outcomes after thoracic surgery for other diseases, the effects of epidural block on major complications after pleurectomy/decortication have not been evaluated. The aim of this study was to evaluate the association between epidural block and major postoperative complications following pleurectomy/decortication.MethodsIn a single-institutional observational study, consecutive adult patients undergoing pleurectomy/decortication under general anesthesia were enrolled from March 2019 to December 2021. Multivariable logistic regression analysis was performed to determine the association between perioperative variables and major complications. Next, patients were divided into two groups: general anesthesia with and without epidural block. Incidences of major postoperative complications, defined as Clavien-Dindo grades≥III, were compared between groups.ResultsIn all patients enrolled with American Society of Anesthesiologists (ASA) physical status II or III (n=99), general anesthesia without epidural block was identified as a sole risk factor for major complications among perioperative variables. The incidence of major complications was 32.3% (95% CI 19.1% to 49.2%) in patients with epidural block (n=34), which was significantly lower than 63.1% (95% CI 50.9% to 73.8%) in patients with epidural block (n=65). In sensitivity analysis in patients with ASA physical status II alone, the same results were obtained.ConclusionEpidural block is likely associated with reduction of the incidence of major complications after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia.

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Complications and Predictive Factors for Air Leak > 10 Days with Neoadjuvant Chemotherapy Followed by Pleurectomy/Decortication for Malignant Pleural Mesothelioma

Cited by 13 publications

References 38 publications

Long-term and short-term prognostic value of the prognostic nutritional index in cancer: a narrative review

Long-term and short-term prognostic value of the prognostic nutritional index in cancer: a narrative review

Surgical Diagnosis of Malignant Pleural Mesothelioma: 20 Years’ Experience at a High-Volume Referral Center

Association between thoracic epidural block and major complications after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia

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