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Kumar R, Mishra N. Lung decortication for spontaneous hydropneumothorax in post COVID patients: A case series. PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2022; 29:100279. [PMID: 35872925 PMCID: PMC9288668 DOI: 10.1016/j.pcorm.2022.100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/04/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Hydropneumothorax is an abnormal collection of air and fluid in the pleural space. As it is a rare complication of COVID-19 pneumonia, we report a case series of spontaneous hydropneumothorax converted to pus collection that was resistant to medical management and treated as decortication and pleurectomy.
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Affiliation(s)
- Rajnish Kumar
- Department of Anaesthesiology, All India Institute of Medical Science Patna, Room no 503, B5A, IPD Building, India
| | - Namita Mishra
- Department of Anaesthesiology, All India Institute of Medical Science Patna, Room no 503, B5A, IPD Building, India
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2
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Meta-analysis of survival after extrapleural pneumonectomy (EPP) versus pleurectomy/decortication (P/D) for malignant pleural mesothelioma in the context of macroscopic complete resection (MCR). Updates Surg 2022; 74:1827-1837. [PMID: 36057027 DOI: 10.1007/s13304-022-01369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE We reviewed the available literature on patients with MPM undergoing either extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D). METHODS Original research studies that evaluated long-term outcomes of P/D versus EPP were identified, from January 1980 to February 2022. The 30-days and 90-day mortality, along with the 1-, 2-, 3-, 5-year survival, the median overall survival, the macroscopic complete resection (MCR) rate, and the complications were calculated according to both a fixed and a random effect model. The Q and I2 statistic were used to test for heterogeneity among the studies. Sensitivity analysis was performed including only studies that incorporated the MCR concept. RESULTS Eighteen studies were included, incorporating a total of 4,852 patients treated with EPP and P/D. The 30-day mortality was significantly higher in the EPP group (OR: 2.79 [95% CI 1.30, 6.01]; p = 0.009). The median overall survival was higher in the P/D group (WMD:-4.55 [-6.05, -3.04]; p < 0.001). No differences were found regarding the 90-day mortality, MCR rate, and the 1-, 2-,3-, 5-year survival between the EPP and P/D groups. These findings were validated by the sensitivity analysis. The incidence of atrial fibrillation, hemorrhage, pulmonary embolism, air leak, and reoperation was significantly increased in the EPP group (p < 0.05). CONCLUSIONS The present meta-analysis indicates that P/D is associated with enhanced outcomes regarding 30-day mortality, median overall survival, and complications. The P/D approach should be preferred when technically feasible. However, the procedure of choice should be decided based on the goal of MCR in the safest approach for the patient.
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Kanayama M, Mori M, Matsumiya H, Taira A, Shinohara S, Takenaka M, Kuroda K, Tanaka F. Surgical strategy for malignant pleural mesothelioma: the superiority of pleurectomy/decortication. Surg Today 2022; 52:1031-1038. [DOI: 10.1007/s00595-021-02437-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
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4
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Sayan M, Eren MF, Gupta A, Ohri N, Kotek A, Babalioglu I, Oskeroglu Kaplan S, Duran O, Derinalp Or O, Cukurcayir F, Kurtul N, Ceylaner Bicakci B, Kutuk T, Senyurek S, Turk A, Jabbour SK, Atalar B. Current treatment strategies in malignant pleural mesothelioma with a treatment algorithm. Adv Respir Med 2019; 87:289-297. [PMID: 31680229 PMCID: PMC10865992 DOI: 10.5603/arm.2019.0051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/24/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022]
Abstract
Malignant pleural mesothelioma (MPM) is arare disease with apoor prognosis. The main therapeutic options for MPM include surgery, chemotherapy, and radiation therapy (RT). Although multimodality therapy has been reported to improve survival, not every medically operable patient is able to undergo all recommended therapy. With improvements in surgical techniques and systemic therapies, as well as advancements in RT, there has been apotential new paradigm in the management of this disease. In this review, we discuss the current literature on MPM management and propose afunctional treatment algorithm.
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Affiliation(s)
- Mutlay Sayan
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.
| | - Mehmet Fuat Eren
- Radiation Oncology Clinic, Marmara University Istanbul Pendik Education and Research Hospital, Istanbul, Turkey
| | - Apar Gupta
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Nisha Ohri
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Ayse Kotek
- Department of Radiation Oncology, Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | - Ibrahim Babalioglu
- Department of Radiation Oncology, Konya Education and Research Hospital, Konya, Turkey
| | - Sedenay Oskeroglu Kaplan
- Department of Radiation Oncology, Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Ozge Duran
- Department of Radiation Oncology, Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Ozlem Derinalp Or
- Department of Radiation Oncology, Adana City Education and Research Hospital, Adana, Turkey
| | - Funda Cukurcayir
- Department of Radiation Oncology, Balikesir Government Hospital, Balikesir, Turkey
| | - Neslihan Kurtul
- Department of Radiation Oncology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Beyhan Ceylaner Bicakci
- Department of Radiation Oncology, Saglik Bilimleri University, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - Tugce Kutuk
- Department of Radiation Oncology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Sukran Senyurek
- Department of Radiation Oncology, Kahramanmaras Necip Fazil City Hospital, Kahramanmaras, Turkey
| | - Ali Turk
- Department of Radiation Oncology, Kahramanmaras Necip Fazil City Hospital, Kahramanmaras, Turkey
| | - Salma K Jabbour
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Banu Atalar
- Department of Radiation Oncology, Mehmet Ali Aydınlar Acıbadem University, School of Medicine, Istanbul, Turkey
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5
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Wu L, Dell'Anno I, Lapidot M, Sekido Y, Chan ML, Kohno M, Serre-Beinier V, Felley-Bosco E, de Perrot M. Progress of malignant mesothelioma research in basic science: A review of the 14th international conference of the international mesothelioma interest group (iMig2018). Lung Cancer 2018; 127:138-145. [PMID: 30642542 DOI: 10.1016/j.lungcan.2018.11.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/25/2018] [Indexed: 02/03/2023]
Abstract
Here we summarize the most recent update of mesothelioma research in basic science presented at the 14th iMig2018 international conference. The symposium of basic science track mainly focused on the drivers of mesothelioma initiation and progression, molecular pathogenesis, and perspectives on potential therapeutic approaches. This review covers several promising fields including strategies efficiently inhibiting YAP/TAZ functions or their critical downstream targets, heparanase inhibitors, RAN depletion, and MIF/CD74 inhibitors that may be developed as novel therapeutic approaches. In addition, targeting mesothelioma stem cells by depleting M2-polarized macrophages in tumor microenvironment or blocking Tnfsf18 (GITRL)-GITR signalling might be translated into therapeutic modalities in mesothelioma treatment.
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Affiliation(s)
- Licun Wu
- Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery and Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, ON, Canada
| | - Irene Dell'Anno
- Department of Biology, University of Pisa, Via Derna 1, Pisa, Italy
| | - Moshe Lapidot
- Division of Thoracic Surgery, Lung Center and International Mesothelioma Program, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Yoshitaka Sekido
- Division of Cancer Biology, Aichi Cancer Center Research Institute, Kanokoden 1-1, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Mei-Lin Chan
- Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery and Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, ON, Canada
| | - Mikihiro Kohno
- Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery and Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, ON, Canada
| | - Veronique Serre-Beinier
- Department of Thoracic and Endocrine Surgery, University Hospitals and University of Geneva, 1211 Geneva 4, Switzerland
| | - Emanuela Felley-Bosco
- Laboratory of Molecular Oncology, University Hospital Zurich, University of Zurich, 8044, Zürich, Switzerland
| | - Marc de Perrot
- Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery and Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, ON, Canada.
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Updated meta-analysis of survival after extrapleural pneumonectomy versus pleurectomy/decortication in mesothelioma. Gen Thorac Cardiovasc Surg 2018; 67:312-320. [PMID: 30374811 DOI: 10.1007/s11748-018-1027-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/24/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We reviewed the available literature on patients with MPM undergoing either extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D). METHODS Original research studies that evaluated long-term outcomes of P/D versus EPP were identified, from January 1990 to July 2018. The 30 and 90 days mortality, along with the 1-, 2-, 3-, 5-year survival, the median overall survival and the complications were calculated according to both a fixed and a random effect model. The Q statistics and I2 statistic were used to test for heterogeneity among the studies. RESULTS Fifteen studies were included, incorporating a total of 1672 patients treated with EPP and 2236 treated with P/D. The 30-day mortality was significantly higher in the EPP group [OR 3.24 (95% CI 1.70, 6.20); p < 0.001]. The median overall survival was significantly increased in the P/D group [WMD - 4.20 (- 5.66, - 2.74); p < 0.001]. No significant differences were found regarding the 90-day mortality and the 1-, 2-, 3-, 5-year survival between the EPP and P/D groups. The incidence of postoperative atrial fibrillation, hemorrhage, empyema, bronchopleural fistula and air leak was significantly increased in the EPP group (p < 0.05). CONCLUSIONS The present meta-analysis indicates that P/D is associated with enhanced outcomes regarding 30-day mortality, median overall survival, and complications. The P/D approach, should, therefore be preferred when technically feasible. However, the decision regarding the procedure of choice should be made on the basis of the disease status and the surgeon's experience. Well-designed, randomized studies, comparing EPP to P/D, are necessary to further assess their clinical outcomes.
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7
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Domen A, Berzenji L, Hendriks JMH, Yogeswaran SK, Lauwers P, Van Meerbeeck JP, Van Schil PE. Extrapleural pneumonectomy: still indicated? Transl Lung Cancer Res 2018; 7:550-555. [PMID: 30450293 DOI: 10.21037/tlcr.2018.07.07] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The optimal treatment of malignant pleural mesothelioma (MPM) has not yet been established and is still under investigation. Surgery is one of the pillars in the multimodality approach with the purpose of removing as much as visible tumor as possible and to relieve symptoms. To date, two major surgical procedures are available for removal or debulking of MPM that is considered to be resectable: [extended (e)] pleurectomy/decortication (P/D) and extrapleural pneumonectomy (EPP). Historically, EPP was regarded as the only way to achieve a macroscopic complete resection. However, in the last years, there is a shift in literature towards (e)P/D as the preferred surgical procedure whenever possible as several retrospective studies and meta-analyses showed a similar or lower long-term survival and higher perioperative mortality and postoperative morbidity in patients who been treated with EPP. On the other hand, no randomized-controlled trials regarding surgical treatment with (e)P/D or EPP exist and therefore level A evidence favoring one surgical procedure is lacking. In this review we provide a nuanced and well-considered answer to the question whether EPP is still indicated in the surgical treatment of MPM.
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Affiliation(s)
- Andreas Domen
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - Lawek Berzenji
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | | | - Patrick Lauwers
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - Jan P Van Meerbeeck
- Division of Thoracic Oncology, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
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