bims-mesote Biomed News
on Mesothelioma
Issue of 2022‒10‒23
two papers selected by
Laura Mannarino
Humanitas Research
  1. Improving outcomes in malignant pleural mesothelioma in an integrated health care system.
  2. Long-term Outcomes and Risk Factors of Residual Thoracic Spaces after Pleurectomy/Decortication for Mesothelioma.
  1. J Thorac Dis. 2022 Sep;14(9): 3352-3363
    Improving outcomes in malignant pleural mesothelioma in an integrated health care system.
    Stephanie Ossowski, Yun-Yi Hung, Kian Banks, Diana Hsu, Lisa Herrinton, Simon Ashiku, Ashish Patel, J Marie Suga, Jeffrey B Velotta.
      Background: Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor that should be managed by an experienced surgical and multidisciplinary group. Our objective was to determine the impact of proficient surgeons and MPM bi-disciplinary review on outcomes of patients with MPM.Methods: Through this cohort study, electronic medical records of 368 adult patients with MPM from 1/1/2009 to 12/31/2020 were reviewed and compared before and after MPM surgeries were regionalized to specialized surgeons and bi-disciplinary review of MPM patient treatment options. We used the Kaplan-Meier method and log-rank tests to compare survival rates by period, by treatment type, and by stage. Patients were followed from cancer diagnosis date until they died or end of study follow-up, whichever occurred first. We also conducted Cox proportional hazards regression model to examine the overall survival (OS) with adjustments for age, histology, stage, and Charlson comorbidity index (CCI).
    Results: Despite similar staging, more patients received any MPM directed treatment from 2015-2020 compared with those patients from 2009-2014. Specifically, there was an increase in patients who received pleurectomy/decortication (PD) from 2015-2020 compared to those who received PD in 2009-2014. Patients with similar age, CCI, stage, and histology had an increase in OS of 12 months with multimodality therapy (surgery, systemic therapy, +/- radiation) compared to those patients who received no treatment.
    Conclusions: Consolidating mesothelioma surgery to a specialized surgical team and regular bi-disciplinary review of MPM cases to determine appropriate multimodality therapy, increases the incorporation of surgical treatments in the management of patients with MPM.
    Keywords:  Malignant pleural mesothelioma (MPM); multimodality therapy; overall survival (OS); pleurectomy/decortication (PD); regionalization
    DOI:  https://doi.org/10.21037/jtd-22-427
  2. Eur J Cardiothorac Surg. 2022 Oct 19. pii: ezac500. [Epub ahead of print]
    Long-term Outcomes and Risk Factors of Residual Thoracic Spaces after Pleurectomy/Decortication for Mesothelioma.
    Akifumi Nakamura, Masaki Hashimoto, Nobuyuki Kondo, Seiji Matsumoto, Toru Nakamichi, Kozo Kuribayashi, Takashi Kijima, Hiroshi Kodama, Koichiro Yamakado, Seiki Hasegawa.
      OBJECTIVES: The residual thoracic spaces (RTS) after pleurectomy/decortication (P/D) remain unexplored to date. Hence, this study aims to examine the details and risk factors of RTS during the 3 post-P/D months.METHODS: We retrospectively examined patients who underwent neoadjuvant chemotherapy, followed by P/D for malignant pleural mesothelioma from September 2012 to December 2020. The RTS group included cases of residual thoracic cavity unaccompanied by pleural effusion on 3 postoperative months computed tomography. We determined risk factors for RTS using univariable and multivariable analyses.
    RESULTS: Of 170 patients examined, 58 (34.1%) were in the RTS group and 112 (65.9%) in the non-RTS group. In the RTS group, 43 patients recovered from RTS during the follow-up period; 4 patients developed chronic fistular empyema, while 2 required fenestration and 2 were thoracoscopic debridement. Besides, 11 patients exhibited RTS continuously. The univariable analysis revealed that compared with the non-RTS group, the RTS group reported a significantly longer postoperative air leak (>7 days; P <0.01) and right P/D (P =0.04). The multivariable analysis demonstrated that longer postoperative air leak (>7 days) remained a risk factor for RTS (odds ratio 2.5, 95% confidence interval: 1.3-4.9, P < 0.01).
    CONCLUSIONS: RTS was a postoperative event that frequently observed in patients undergoing P/D. Overall, the current study findings suggest longer postoperative air leak (>7 days) as a significant risk factor for RTS.
    Keywords:  decortication; mesothelioma; pleurectomy; residual thoracic space
    DOI:  https://doi.org/10.1093/ejcts/ezac500
This page is being maintained by Thomas Krichel. It was last updated on 2022‒10‒31 at 07:26:00.