Video-Assisted Thoracoscopic Pleurectomy in the Management of Malignant Pleural Effusion

Waller, David; Morritt, G. N.; Forty, J.

doi:10.1378/chest.107.5.1454

Cited by 81 publications

(39 citation statements)

References 11 publications

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“…At present there is an absence of randomised trials, but a national study is ongoing in the UK which is being supported by the National Cancer Research Institute comparing VATS debulking with chemical pleurodesis (MesoVATS). There are a small series of retrospective studies which provide low-grade evidence for debulking pleurectomy [44][45][46][47]. The associated morbidity of thoracotomy may diminish the benefits [48]; however there is limited but emerging evidence that VATS can provide good symptom control and may have a beneficial effect on survival [46].…”

Section: Evidencementioning

confidence: 99%

Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma

Scherpereel¹,

Astoul²,

Baas³

et al. 2009

Eur Respir J

548

504

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Malignant pleural mesothelioma (MPM) is a rare tumour but with increasing incidence and a poor prognosis. In 2008, the European Respiratory Society/European Society of Thoracic Surgeons Task Force brought together experts to propose practical and up-to-dated guidelines on the management of MPM.To obtain an earlier and reliable diagnosis of MPM, the experts recommend performing thoracoscopy, except in cases of pre-operative contraindication or pleural symphysis. The standard staining procedures are insufficient in ,10% of cases. Therefore, we propose using specific immunohistochemistry markers on pleural biopsies. In the absence of a uniform, robust and validated staging system, we advice use of the most recent TNM based classification, and propose a three step pre-treatment assessment. Patient's performance status and histological subtype are currently the only prognostic factors of clinical importance in the management of MPM. Other potential parameters should be recorded at baseline and reported in clinical trials. MPM exhibits a high resistance to chemotherapy and only a few patients are candidates for radical surgery. New therapies and strategies have been reviewed.Because of limited data on the best combination treatment, we emphasise that patients who are considered candidates for a multimodal approach should be included in a prospective trial at a specialised centre.

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Section: Evidencementioning

confidence: 99%

Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma

Scherpereel¹,

Astoul²,

Baas³

et al. 2009

Eur Respir J

548

504

View full text Add to dashboard Cite

show abstract

“…Following initial reports of the feasibility of video assisted debulking surgery for mesothelioma (11) there were reports of symptomatic improvement (12) and possible survival benefit (13). We, therefore, undertook a randomised, controlled trial in patients with any subtype of confirmed or suspected mesothelioma with pleural effusion, recruited from 12 hospitals in the UK.…”

Section: Mesovats (Clinicaltrialsgov Nct00821860)mentioning

confidence: 99%

Randomized controlled trials in malignant pleural mesothelioma surgery—mistakes made and lessons learned

Waller

Dawson

2017

Ann. Transl. Med.

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Randomized surgical trials are of the most difficult to design and recruit, however, they are the only robust method available to establish a new surgical procedure. Mesothelioma is a disease with a perceived poor prognosis for which surgical intervention has relatively high complications and not insignificant mortality. This review will consider the mesothelioma and radical surgery (MARS) 1 and 2 trials, SAKK 17/04 trial and the EORTC 1205 trial all aimed at assessing the potential benefit of radical surgery for malignant pleural mesothelioma. In addition, MesoVATS and MesoTRAP will be explored assessing the value of debulking surgery for malignant pleural mesothelioma. We also endeavour to identify the mistakes made and the lessons learned which will inform future randomized controlled clinical trials in the field of malignant pleural mesothelioma. Despite the insurmountable problems with randomized controlled clinical trials, we show that they are possible and continuing with uncontrolled experiments will perpetuate unproven and potentially harmful operations.

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“…Thoracotomy with pleurectomy can sometimes be a valid alternative, but it has significant morbidity and mortality, and needs to be applied to patients in good physical condition and with a reasonably long expected survival [9]. Video-assisted thoracoscopic pleurectomy has gained acceptance in recent years, and has achieved good results in selected patients, especially those with mesothelioma [10].…”

Section: Is the Lung Re-expandable?mentioning

confidence: 99%

Pleurodesis: state of the art

Rodríguez-Panadero

Antony²

1997

Eur Respir J

169

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Pleurodesis aims to achieve a symphysis between parietal and visceral pleural surfaces, in order to prevent accumulation of fluid or air in the pleural space. Its major indications are malignant effusions and pneumothorax, and a reexpandable lung is essential for the success of the technique. Moreover, expectation of a reasonably long survival is important before attempting pleurodesis.A successful lung re-expansion is unlikely if the pleural pressure falls more than 20 cmH 2 O·L -1 of fluid removed, because there is a central bronchial obstruction or the lung is trapped by tumour and/or fibrin. Pleural fluid pH (<7.20) is a good indicator of the presence of trapped lung; moreover, a successful pleurodesis is less likely when pH is low, and this parameter is also a good predictor for survival of the patients.Among the many sclerosing agents that have been used for pleurodesis, talc has achieved the best results, with an average success rate of approximately 90%. The cellular and biochemical mechanisms involved in pleurodesis may be specific to the agent used, however, they may all follow a common final pathway leading to activation of the pleural coagulation cascade, the appearance of fibrin networks, and the proliferation of fibroblasts. The details of these mechanisms are still unclear and need to be further elaborated. Eur Respir J 1997; 10: 1648-1654 The aim of pleurodesis is to achieve a symphysis between visceral and parietal pleural layers, in order to prevent accumulation of either air or fluid in the pleural space. Its main indications are malignant pleural effusions and pneumothorax. The choice of the right technique, sclerosing agent to be applied, criteria for selection of patients and evaluation of results are important and controversial issues. Furthermore, there is little information about the mechanisms that lead to pleural symphysis or the factors that influence the outcome of pleurodesis. Pleurodesis in malignant effusionsRecurrent effusions of malignant origin are by far the most common indication for pleurodesis in clinical practice. This is because there is a lack of effective antitumoral treatment at later stages of the disease, and because palliative measures are necessary to improve symptoms related to the pleural effusion. Repeated thoracenteses are not usually suitable, since they may be troublesome to the patient and provoke important protein loss (about 40 g·L -1 of pleural fluid that is withdrawn), with infection of the pleural space as an added risk.

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Video-Assisted Thoracoscopic Pleurectomy in the Management of Malignant Pleural Effusion

Cited by 81 publications

References 11 publications

Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma

Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma

Randomized controlled trials in malignant pleural mesothelioma surgery—mistakes made and lessons learned

Pleurodesis: state of the art

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