Extrapleural pneumonectomies for pleural mesothelioma

Faccioli, Eleonora; Bellini, Alice; Mammana, Marco; Monaci, Nicola; Schiavon, Marco; Rea, Federico

doi:10.1080/17476348.2020.1688147

Cited by 3 publications

(4 citation statements)

References 66 publications

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“…Moreover, EPP was associated with a significantly higher 30-day mortality rate (10.5 vs. 3.1%). 3,4 Given its inauspicious nature, also compared with other type of solid tumors, pushing the limits of ECLS for adults with respiratory or cardiac failure after surgery for mesothelioma represents an ethical dilemma. Fica et al reported the use of a single-site veno-venous ECMO as an alternative to invasive ventilation in postpneumonectomy fistula occurring 30 days after surgery for mesothelioma, 8 but to the best of our knowledge, V-A ECMO has not previously been used as an emergency assistance device for complicated mesothelioma patients.…”

Section: Discussionmentioning

confidence: 99%

“…Selected patients, with early stage and epithelial disease, could benefit from a multimodality treatment, including surgery, chemotherapy, and/or radiotherapy, 2 often associated to major and minor perioperative morbidities. 3,4 Herein, we report the use of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) as bridge to recovery in three different patients suffering from cardiorespiratory perioperative life-threatening complications following surgery for mesothelioma after induction chemotherapy (iCT).…”

Section: Introductionmentioning

confidence: 99%

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ECLS for Life-Threatening Complications in Mesothelioma Surgery: Is It Worthwhile?

Bellini

Dell’Amore

Ferrigno

et al. 2021

Thorac Cardiovasc Surg

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Extracorporeal life support (ECLS) is an effective method for bridging patients to recovery in cases of respiratory and/or cardiac failure that are potentially reversible and unresponsive to conventional management. Nevertheless, there have been only few reports about the use of ECLS in oncological patients with complications due to their neoplasm or its treatment. We report the use of veno-arterial extracorporeal membrane oxygenation in three cases of severe perioperative complications following surgery for mesothelioma after induction chemotherapy at our Institution.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

ECLS for Life-Threatening Complications in Mesothelioma Surgery: Is It Worthwhile?

Bellini

Dell’Amore

Ferrigno

et al. 2021

Thorac Cardiovasc Surg

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“…This is the reason why until now there is not a unique therapeutic approach for MPM and physicians base their decision according to their expertise, the performance status of the patient and the characteristic of the neoplasm. Anyhow, it is important that the sick person and his relatives acquire satisfactory information about both the disease and the available treatments [52].…”

Section: Figure 2 (A and B) Pleurectomy/decortication (Pd) (C) Pathol...mentioning

confidence: 99%

“…The multimodality therapies including surgery offered to selected cases (early stages with epithelial histology) are often characterized by major and/or minor perioperative morbidities [13]. According to Burt et al, the EPP is burdened by a significantly higher rate of acute distress respiratory syndrome (ARDS) (8.4 vs. 0.8%) and 30-day mortality (10.5 vs. 3.1%), compared to the PD [52,59]. Anyhow, in the case of perioperative complications after surgery for MPM the employment of ECLS represents an ethical dilemma due to the fatal nature of this malignancy.…”

Section: Extracorporeal Life Support (Ecls) For Life-threatening Comp...mentioning

confidence: 99%

Surgical Management of Malignant Pleural Mesothelioma: From the Past to the Future

Bellini¹,

Aramini²,

Stella³

2022

Mesothelioma - Diagnostics, Treatment and Basic Research

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Malignant pleural mesothelioma (MPM) is an aggressive malignancy with a poor prognosis, principally caused by a prior asbestos exposure. Up to the present, multimodality protocols including surgery with chemotherapy (CT) and/or radiotherapy (RT) represent the therapeutic gold standard for selected patients (epithelial and early-stage MPM). In this context, the aim of surgery is to accomplish the macroscopic complete resection (MCR). There are two main surgical options to obtain MCR—extrapleural pneumonectomy (EPP) and pleurectomy/decortication (PD). The superiority of one surgical approach over the other is still discussed. To date, the decision to carry out one or the other in a multimodal setting is established on surgeons’ preference more than on strong scientific evidence. Due to the high morbidity, both surgical techniques should be achieved in tertiary referral centres. In summary, surgery, CT, and RT have failed as single modality therapies with no effects on patients survival. This aspect may be justified by the lack of randomized trials. Thus, novel therapeutic strategies, such as multimodality treatment and targeted agents, seem to prolong the survival and the quality of life. The aim of this chapter is to provide a complete overview of the current surgical approaches to MPM, discussing within the frameworks of pre-operative diagnostic evaluation and multimodality oncological treatments.

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Relapse Patterns and Tailored Treatment Strategies for Malignant Pleural Mesothelioma Recurrence after Multimodality Therapy

Bellini

Dell’Amore

Terzi

et al. 2021

JCM

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To date, there have been no established therapies for recurrent malignant pleural mesothelioma (MPM) after multimodality treatment. Aims of this retrospective study are to analyze the recurrence pattern, its treatment and to identify the predictors of best oncological outcomes for relapsed MPM, comparing extrapleural pneumonectomy (EPP) vs. pleurectomy/decortication (PD). Study population: 94 patients with recurrence of MPM after multimodality treatment underwent macroscopic complete resection (52.1% with EPP and 47.9% with PD) between July 1994 and February 2020. Distant spread was the most frequent pattern of recurrence (71.3%), mostly in the EPP group, while the PD group showed a higher local-only failure rate. Post-recurrence treatment was administered in 86.2%, whereas best supportive care was administered in 13.8%. Median post-recurrence survival (PRS) was 12 months (EPP 14 vs. PD 8 months, p = 0.4338). At multivariate analysis, predictors of best PRS were epithelial histology (p = 0.026, HR0.491, IC95%0.263–0.916), local failure (p = 0.027, HR0.707, IC95%0.521–0.961), DFS ≥ 12 months (p = 0.006, HR0.298, IC95%0.137–0.812) and post-recurrence medical treatment (p = 0.046, HR0.101, IC95%0.897–0.936). The type of surgical intervention seems not to influence the PRS if patients are fit enough to face post-recurrence treatments. In patients with a prolonged disease-free interval, in the case of recurrence the most appropriate treatment seems to be the systemic medical therapy, even in the case of local-only relapse.

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Extrapleural pneumonectomies for pleural mesothelioma

Cited by 3 publications

References 66 publications

ECLS for Life-Threatening Complications in Mesothelioma Surgery: Is It Worthwhile?

ECLS for Life-Threatening Complications in Mesothelioma Surgery: Is It Worthwhile?

Surgical Management of Malignant Pleural Mesothelioma: From the Past to the Future

Relapse Patterns and Tailored Treatment Strategies for Malignant Pleural Mesothelioma Recurrence after Multimodality Therapy

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