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Liou DZ, Berry MF, Brown LM, Demmy TL, Huang J, Khullar OV, Padda SK, Shah RD, Taylor MD, Toker SA, Weiss E, Wightman SC, Worrell SG, Hayanga JWA. The Society of Thoracic Surgeons Expert Consensus Document on the Surgical Management of Thymomas. Ann Thorac Surg 2024:S0003-4975(24)00338-2. [PMID: 38718878 DOI: 10.1016/j.athoracsur.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Lisa M Brown
- Division of General Thoracic Surgery, Department of Surgery, UC Davis Health, Sacramento, California
| | - Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Onkar V Khullar
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Sukhmani K Padda
- Department Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Rachit D Shah
- Section of Thoracic and Foregut Surgery, VCU Health System, Richmond, Virginia
| | - Matthew D Taylor
- Division of Thoracic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Seyfi Alper Toker
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Elisabeth Weiss
- Department of Radiation Oncology, VCU Health, Richmond, Virginia
| | - Sean C Wightman
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Stephanie G Worrell
- Thoracic Surgery Section, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - J W Awori Hayanga
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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Klotz LV, Zimmermann J, Müller K, Kovács J, Hassan M, Koller M, Schmid S, Huppertz G, Markowiak T, Passlick B, Hofmann HS, Winter H, Hatz RA, Eichhorn ME, Ried M. Multimodal Treatment of Pleural Mesothelioma with Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy: Impact of Additive Chemotherapy. Cancers (Basel) 2024; 16:1587. [PMID: 38672669 PMCID: PMC11048892 DOI: 10.3390/cancers16081587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Cytoreductive surgery (CRS) combined with hyperthermic intrathoracic chemoperfusion (HITOC) is a promising treatment strategy for pleural mesothelioma (PM). The aim of this study was to evaluate the impacts of this multimodal approach in combination with systemic treatment on disease-free survival (DFS) and overall survival (OS). In this retrospective multicenter study, clinical data from patients after CRS and HITOC for PM at four high-volume thoracic surgery departments in Germany were analyzed. A total of 260 patients with MPM (220 epithelioid, 40 non-epithelioid) underwent CRS and HITOC as part of a multimodal treatment approach. HITOC was administered with cisplatin alone (58.5%) or cisplatin and doxorubicin (41.5%). In addition, 52.1% of patients received neoadjuvant and/or adjuvant chemotherapy. The median follow-up was 48 months (IQR = 38 to 58 months). In-hospital mortality was 3.5%. Both the resection status (macroscopic complete vs. incomplete resection) and histologic subtype (epithelioid vs. non-epithelioid) had significant impacts on DFS and OS. In addition, adjuvant chemotherapy (neoadjuvant/adjuvant) significantly increased DFS (p = 0.003). CRS and HITOC within a multimodal treatment approach had positive impacts on the survival of patients with epithelioid PM after macroscopic complete resection. The addition of chemotherapy significantly prolonged the time to tumor recurrence or progression.
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Affiliation(s)
- Laura V. Klotz
- Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, 69126 Heidelberg, Germany
- German Center for Lung Research (DZL), 69120 Heidelberg, Germany
| | - Julia Zimmermann
- Division of Thoracic Surgery, Ludwig-Maximilians-University Munich, Asklepios Lung Clinic Gauting, 82131 Gauting, Germany; (J.Z.); (J.K.)
| | - Karolina Müller
- Center for Clinical Studies, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Julia Kovács
- Division of Thoracic Surgery, Ludwig-Maximilians-University Munich, Asklepios Lung Clinic Gauting, 82131 Gauting, Germany; (J.Z.); (J.K.)
| | - Mohamed Hassan
- Department of Thoracic Surgery, University Hospital Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Severin Schmid
- Department of Thoracic Surgery, University Hospital Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Gunnar Huppertz
- Center for Clinical Studies, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Till Markowiak
- Department of Thoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, University Hospital Freiburg, 79106 Freiburg im Breisgau, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Department of Thoracic Surgery, Barmherzige Brüder Hospital Regensburg, 93049 Regensburg, Germany
| | - Hauke Winter
- Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, 69126 Heidelberg, Germany
- German Center for Lung Research (DZL), 69120 Heidelberg, Germany
| | - Rudolf A. Hatz
- German Center for Lung Research (DZL), 69120 Heidelberg, Germany
- Division of Thoracic Surgery, Ludwig-Maximilians-University Munich, Asklepios Lung Clinic Gauting, 82131 Gauting, Germany; (J.Z.); (J.K.)
| | - Martin E. Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, 69126 Heidelberg, Germany
- German Center for Lung Research (DZL), 69120 Heidelberg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
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Dawson AG, Kutywayo K, Mohammed SB, Fennell DA, Nakas A. Cytoreductive surgery with hyperthermic intrathoracic chemotherapy for malignant pleural mesothelioma: a systematic review. Thorax 2023; 78:409-417. [PMID: 35410957 DOI: 10.1136/thoraxjnl-2021-218214] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 02/23/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Cytoreductive surgery has been used a part of multimodality treatment in patients with malignant pleural mesothelioma (MPM). The residual microscopic disease that remains will lead to disease progression in the majority of patients. Delivery of hyperthermic intrathoracic chemotherapy at the time of surgery has been used to address this microscopic disease, however it's effect and place in the multimodality treatment sphere is unknown. The aim of this systematic review was to assess the effect of surgery and hyperthermic intrathoracic chemotherapy in patients with MPM on overall survival and disease-free interval. METHODS Ovid MEDLINE, Embase, Web of Science and the Cochrane Database of Systematic Reviews were searched from database inception through to June 2021. Studies reporting overall survival and/or disease-free interval in patients with MPM undergoing cytoreductive surgery with hyperthermic intrathoracic chemotherapy were considered. Study quality was assessed using the Newcastle-Ottawa Scale. A narrative review was performed. RESULTS Fifteen studies were eligible for inclusion comprising 598 patients. Surgery with hyperthermic intrathoracic chemotherapy was associated with a median overall survival and disease-free interval ranging from 11 to 75 months and 7.2 to 57 months, respectively. These appeared to be superior to patients not receiving hyperthermic intrathoracic chemotherapy (overall survival: 5-36 months and disease-free interval: 12.1-21 months). A higher dose of hyperthermic intrathoracic chemotherapy was associated with an improvement in overall survival compared with a lower dose: 18-31 months versus 6-18 months, respectively. The most common morbidity was atrial fibrillation followed by renal complications. CONCLUSION Surgery with hyperthermic intrathoracic chemotherapy offers a safe and effective therapy with an improvement in disease-free interval and overall survival, particularly when hyperthermic intrathoracic chemotherapy is administered at a higher dose. PROSPERO REGISTRATION NUMBER CRD42019129002.
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Affiliation(s)
- Alan G Dawson
- Department of Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK .,Department of Cancer Studies, University of Leicester, Leicester, UK
| | - Kudzayi Kutywayo
- Department of Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Seid B Mohammed
- Department of Statistics, University of Leicester Clinical Trials Unit, Leicester, UK
| | - Dean A Fennell
- Department of Cancer Studies, University of Leicester, Leicester, UK.,Department of Medical Oncology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Apostolos Nakas
- Department of Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Zhou Y, Xu M. Analysis of the Effect of Quality Nursing on Recovery after Thoracic Surgery. Emerg Med Int 2022; 2022:6204832. [PMID: 36247703 PMCID: PMC9568356 DOI: 10.1155/2022/6204832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To observe the feasibility and safety of rapid rehabilitation nursing in the perioperative period of thoracoscopic treatment of lung cancer patients. Rapid rehabilitation nursing was compared with conventional perioperative nursing to explore its clinical efficacy, i.e., its advantages in improving postoperative comfort, postoperative rehabilitation efficiency, and hospitalization cost of patients undergoing thoracoscopic lung cancer resection. Methods We carried out a retrospective analysis of 337 lung cancer patients who underwent lobectomy in our thoracic surgery department from July 2019 to June 2021, of which 168 lung cancer patients whose perioperative care method was traditional rehabilitation care were classified as A and 169 lung cancer patients who started to implement the intelligent medical intervention method in the department in September were classified as intelligent medical B. By reviewing patient cases and departmental statistics, general information, length of stay, hospitalization cost, complication rate, pain score, bowel movement recovery time, and pulmonary function index of the two groups A and B were compared. Nursing satisfaction was investigated by using a questionnaire. All the data in the study were processed and analyzed using SPSS 17.0 software. Results There were no differences in preoperative general data, pathological findings, preoperative underlying diseases, lesion involvement sites, and postoperative TNM stages (P > 0.05), which were comparable; the incidence of postoperative pulmonary infection and atelectasis complications, postoperative hospitalization time, and hospitalization cost were lower in group B than in group A; the postoperative chest tube drain placement time was shorter in group B than in group A, and the difference between the two groups was statistically significant (P < 0.05). The incidence of postoperative pain and discomfort in group B was lower than that in group A, and the difference between the two groups was statistically significant (P < 0.05); the incidence of postoperative chest pain, bleeding, pneumothorax, pulmonary infection, and atelectasis in group B was lower than that in group A, and the difference between the two groups was statistically significant (P < 0.05). Conclusion Intelligent medical rehabilitation nursing has good application value in thoracoscopic lung cancer surgery. Applying the concept of intelligent medical rehabilitation nursing provides an important experimental basis and theoretical basis for improving the postoperative survival quality and clinical symptoms of patients undergoing thoracoscopic lung cancer resection, which helps to promote the postoperative recovery of patients with thoracoscopic lung cancer, improves the recovery efficiency of patients and their overall quality of life, and is superior to the conventional nursing group.
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Affiliation(s)
- Yujing Zhou
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
| | - Ming Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, China
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Current Management and Future Perspective in Pleural Mesothelioma. Cancers (Basel) 2022; 14:cancers14041044. [PMID: 35205798 PMCID: PMC8869935 DOI: 10.3390/cancers14041044] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 11/16/2022] Open
Abstract
Pleural mesothelioma is an aggressive malignancy arising from pleural mesothelial cell lining, predominantly associated with prior exposure to asbestos. The ban on asbestos use has led to its lower incidence in many countries, but globally the disease burden is expected to rise. Therefore, well-planned research is needed to develop more effective, tolerable and affordable drugs. The development of novel treatment has been too slow, with only two regimens of systemic therapy with robust phase 3 data approved formally to date. The treatment scenario for resectable disease remains controversial. However, recent developments in the understanding of disease and clinical trials have been encouraging, and may add better treatment options in the coming years. In this review, we discuss the current treatment options for pleural mesothelioma and shed light on some recent studies and ongoing trials.
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