bims-mesote 2022-10-23 papers

Issue of 2022–10–23
two papers selected by
Laura Mannarino, Humanitas Research

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

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