The role of video assisted thoracoscopic pleurectomy/decortication in the therapeutic management of malignant pleural mesothelioma☆

Analysis of our results demonstrates that the 30-day mortality rate of extrapleural pneumonectomy in our patients who were older than 65 at the time of diagnosis was 23% compared to an observed mortality of 6.75% in the general EPP population, and 12.5% in the radical pleurectomy decortication >65 group and 7.1% in the video assisted thoracic surgery P/D group

A NAKAS

2007

Scholarcy highlights

  • Surgical treatment of malignant pleural mesothelioma remains controversial
  • The single death in the radical pleurectomy decortication group occurred due to pulmonary embolism and the three deaths in the video assisted thoracic surgery P/D group were all a result of pleural and/or lung sepsis and associated complications
  • Whilst initially P/D was considered by some to have better results than extrapleural pneumonectomy, in a second study by the same authors 3 years after the first the type of surgical resection was not significant for the survival
  • Radical P/D is offered to patients who are pN2 positive on mediastinoscopy and have limited prognosis or do not have the respiratory reserve for a pneumonectomy
  • Analysis of our results demonstrates that the 30-day mortality rate of EPP in our patients who were older than 65 at the time of diagnosis was 23% compared to an observed mortality of 6.75% in the general EPP population, and 12.5% in the radical P/D >65 group and 7.1% in the VATS P/D group
  • We believe that VATS P/D is the only method to effectively palliate this subgroup of malignant mesothelioma patients with trapped lung who are not candidates for radical surgery without the complications of thoracotomy
  • We believe that video assisted thoracic surgery pleurectomy decortication is the only method to effectively palliate this subgroup of malignant mesothelioma patients with trapped lung who are not candidates for radical surgery without the complications of thoracotomy

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