1
|
Zhang YZ, Brambilla C, Molyneaux PL, Rice A, Robertus JL, Jordan S, Lim E, Lang-Lazdunski L, Begum S, Dusmet M, Anikin V, Beddow E, Finch J, Asadi N, Popat S, Quesne JL, Husain AN, Cookson WOCM, Moffatt MF, Nicholson AG. Presence of pleomorphic features but not growth patterns improves prognostic stratification of epithelioid malignant pleural mesothelioma by 2-tier nuclear grade. Histopathology 2020; 77:423-436. [PMID: 32333813 DOI: 10.1111/his.14127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022]
Abstract
AIMS Nuclear grade has been recently validated as a powerful prognostic tool in epithelioid malignant pleural mesothelioma (E-MPM). In other studies histological parameters including pleomorphic features and growth patterns were also shown to exert prognostic impact. The primary aims of our study are (i) externally validate the prognostic role of pleomorphic features in E-MPM and (ii) investigate if evaluating growth pattern in addition to 2-tier nuclear grade improves prognostication. METHODS AND RESULTS 614 consecutive cases of E-MPM from our institution over a period of 15 years were retrospectively reviewed, of which 51 showed pleomorphic features. E-MPM with pleomorphic features showed significantly worse overall survival compared to those without (5.4 versus 14.7 months). Tumours with predominantly micropapillary pattern showed the worst survival (6.2 months) followed by solid (10.5 months), microcystic (15.3 months), discohesive (16.1 months), trabecular (17.6 months) and tubulo-papillary (18.6 months). Sub-classification of growth patterns into high grade (solid, micropapillary) and low grade (all others) led to good separation of overall survival (10.5 versus 18.0 months) but did not predict survival independent of 2-tier nuclear grade. A composite score comprised of growth pattern and 2-tier nuclear grade did not improve prognostication compared with nuclear grade alone. Intra-tumoural heterogeneity in growth patterns is ubiquitous. CONCLUSIONS Our findings support the incorporation of E-MPM with pleomorphic features in the epithelioid subtype as a highly aggressive variant distinct from 2-tier nuclear grade. E-MPM demonstrates extensive heterogeneity in growth pattern but its evaluation does not offer additional prognostic utility to 2-tier nuclear grade.
Collapse
Affiliation(s)
- Yu Z Zhang
- National Centre for Mesothelioma Research, National Heart & Lung Institute, Imperial College London, London, UK.,Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Cecilia Brambilla
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Philip L Molyneaux
- National Heart & Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Clinical Research Facility, Royal Brompton Hospital, London, UK
| | - Alexandra Rice
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Jan L Robertus
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Simon Jordan
- Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Eric Lim
- National Heart & Lung Institute, Imperial College London, London, UK.,Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Sofina Begum
- Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Michael Dusmet
- Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Vladimir Anikin
- Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Department of Oncology and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Emma Beddow
- Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jonathan Finch
- Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Nizar Asadi
- Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Sanjay Popat
- National Heart & Lung Institute, Imperial College London, London, UK.,Department of Medicine, Royal Marsden Hospital NHS Foundation Trust, London, UK.,Institute of Cancer Research, London, UK
| | - John L Quesne
- MRC Toxicology Unit, University of Cambridge, Leicester, UK.,Leicester Cancer Research Centre, University of Leicester, Leicester, UK.,Department of Cellular Pathology, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Aliya N Husain
- Department of Pathology, University of Chicago Medical Centre, Chicago, USA
| | - William O C M Cookson
- National Centre for Mesothelioma Research, National Heart & Lung Institute, Imperial College London, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Miriam F Moffatt
- National Centre for Mesothelioma Research, National Heart & Lung Institute, Imperial College London, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart & Lung Institute, Imperial College London, London, UK
| |
Collapse
|
2
|
Nicholson AG, Sauter JL, Nowak AK, Kindler HL, Gill RR, Remy-Jardin M, Armato SG, Fernandez-Cuesta L, Bueno R, Alcala N, Foll M, Pass H, Attanoos R, Baas P, Beasley MB, Brcic L, Butnor KJ, Chirieac LR, Churg A, Courtiol P, Dacic S, De Perrot M, Frauenfelder T, Gibbs A, Hirsch FR, Hiroshima K, Husain A, Klebe S, Lantuejoul S, Moreira A, Opitz I, Perol M, Roden A, Roggli V, Scherpereel A, Tirode F, Tazelaar H, Travis WD, Tsao MS, van Schil P, Vignaud JM, Weynand B, Lang-Lazdunski L, Cree I, Rusch VW, Girard N, Galateau-Salle F. EURACAN/IASLC Proposals for Updating the Histologic Classification of Pleural Mesothelioma: Towards a More Multidisciplinary Approach. J Thorac Oncol 2020; 15:29-49. [DOI: 10.1016/j.jtho.2019.08.2506] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022]
|
3
|
Zhang Y, Brambilla C, Rice A, Robertus J, Jordan S, Lim E, Lang-Lazdunski L, Popat S, Moffatt M, Cookson W, Nicholson A. MA12.02 Growth Patterns in Epithelioid Malignant Pleural Mesothelioma: A Clinicopathological Review of 614 Cases Over 15 Years. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
4
|
Lang-Lazdunski L, Zhang Y, Popat S, O'Brien M, Steele J, Newsom-Davis T, Scherpereel A, Bouchaab H, Rice A, Nicholson A. MA05.01 Second or Third Line Anti-PD-1 Therapy After Multimodality Therapy Including Total Pleurectomy in Malignant Pleural Mesothelioma. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Lang-Lazdunski L, Zhang Y, Popat S, O'Brien M, Steele J, Newsom-Davis T, Lal R, Nicholson A. P2.06-05 Multimodality Therapy Using Total Pleurectomy in Malignant Pleural Mesothelioma: Long-Term Outcomes in 150 Consecutive Cases. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
6
|
Lococo F, Torricelli F, Lang-Lazdunski L, Veronesi G, Rena O, Paci M, Casadio C, Piana S, Novellis P, Di Stefano TS, Ciarrocchi A, Billè A. Survival results in biphasic malignant pleural mesothelioma patients: A multicentric analysis. J Thorac Cardiovasc Surg 2019; 159:1584-1593.e2. [PMID: 31590954 DOI: 10.1016/j.jtcvs.2019.08.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 07/20/2019] [Accepted: 08/03/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The best strategy of care for biphasic malignant pleural mesothelioma (Biph-MPM) is controversial. In this study, a large dataset of Biph-MPM cases was reviewed to identify prognostic factors and to evaluate the role of a multimodal approach, including cancer-directed surgery. METHODS A total of 213 patients with Biph-MPM treated at 4 tertiary centers who experienced MPM from January 2009 to December 2016 were selected, and clinical, pathologic, and surgical information was retrieved. A Cox regression model was used to identify predictors of survival, and the Kaplan-Meier method was used to summarize overall survival. RESULTS The mean age and the male/female ratio were 68.4 ± 9.5 years and 5:1, respectively. Tumors were assigned to stages I (127, 59.6%), II (3, 1.4%), III (76, 35.4%), and IV (7, 3.3%) according to the Eighth Tumor, Node, Metastasis (TNM) edition. A multimodal treatment including pleurectomy/decortication was performed in 58 patients (27.2%), chemotherapy alone in 99 patients (46.5%), and best supportive care in 56 (26.3%). The median overall survival was 11 months. A univariate analysis revealed that survival was significantly associated with the percentage forced expiratory volume in 1 second (P < .0001), performance status (P = .0002), multimodal treatment including surgery (P < .0001), and TNM stage (P = .011). A multivariable analysis confirmed performance status, percentage forced expiratory volume in 1 second, TNM, and a multimodal approach as independent variables affecting long-term survival. CONCLUSIONS Despite the overall poor prognosis of biphasic histology, a multimodal approach, including cancer-directed surgery, is associated with improved long-term results in very selected patients with Biph-MPM.
Collapse
Affiliation(s)
- Filippo Lococo
- Unit of Thoracic Surgery, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giulia Veronesi
- Unit of Thoracic Surgery, Humanitas Research Hospital, Milan, Italy
| | - Ottavio Rena
- Unit of Thoracic Surgery, University of Novara, Novara, Italy
| | - Massimiliano Paci
- Unit of Thoracic Surgery, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Simonetta Piana
- Unit of Pathology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Alessia Ciarrocchi
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Billè
- Unit of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| |
Collapse
|
7
|
Moser B, Fadel E, Fabre D, Keshavjee S, de Perrot M, Thomas P, Brioude G, Van Raemdonck D, Viskens S, Lang-Lazdunski L, Bille A, Weder W, Jungraithmayr W, Ruffini E, Guerrera F, Gómez de Antonio D, Liberman M, Novoa N, Scarci M, Janik S, Klepetko W. Surgical therapy of thymic tumours with pleural involvement: an ESTS Thymic Working Group Project. Eur J Cardiothorac Surg 2018; 52:346-355. [PMID: 28449028 PMCID: PMC5848821 DOI: 10.1093/ejcts/ezx090] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/26/2017] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES: Surgery for thymic epithelial tumours (TETs) with pleural involvement is infrequently performed. Thus, the value of surgical therapy for primary or recurrent TETs with pleural involvement is not sufficiently defined yet. METHODS: Twelve institutions contributed retrospective data on 152 patients undergoing surgery (1977–2014) on behalf of the ESTS Thymic Working group. Outcome measures included overall (OS), cause-specific (CSS) and disease-free (DFS) survival as well as freedom from recurrence (FFR). RESULTS: In 70.4% of cases, pleural involvement was present at the time of primary intervention, whereas 29.6% had surgery for recurrent disease involving the pleura. Pleural involvement resulted from thymomas (88.8%) and thymic carcinomas (11.2%). Forty extrapleural pneumonectomies (EPPs), 23 total pleurectomies (TPs), and 88 local pleurectomies (LPs) were performed (completeness of resection in 76.8%). OS for the entire patient population at 1, 3, 5 and 10 years was 96.4%, 91.0%, 87.2% and 62.7%, respectively. There was no statistically significant difference regarding FFR and OS for patients with local or advanced disease undergoing EPP, TP or LP. Thymic carcinomas in comparison with thymomas had a negative impact on OS [hazard ratio 6.506, P = 0.002], CSS and FFR. Incomplete resections predicted worse OS [hazard ratio 6.696, P = 0.003]. CONCLUSIONS: Complete resection remains the mainstay of treatment for TETs with pleural involvement. Study populations treated with EPP, TP and LP had similar survival that may be factual as observed, but in the presence of selection bias, we can further conclude from the results that EPP, TP and LP are equally effective procedures. Procedural choice depends upon the extent of tumour distribution. EPPs, TPs and LPs performed within a multimodality setting seem to be efficient procedures for local control of disease, as they yield excellent results regarding OS, DFS, CSS and FFR.
Collapse
Affiliation(s)
- Bernhard Moser
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Paris Sud University, Paris, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie-Lannelongue Hospital, Paris Sud University, Paris, France
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Pascal Thomas
- Department of Thoracic Surgery, Aix-Marseille University, Marseille, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, Aix-Marseille University, Marseille, France
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sophie Viskens
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Loic Lang-Lazdunski
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | | | - Enrico Ruffini
- Department of Surgery, Section of Thoracic Surgery, University of Torino, Torino, Italy
| | - Francesco Guerrera
- Department of Surgery, Section of Thoracic Surgery, University of Torino, Torino, Italy
| | - David Gómez de Antonio
- Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Moishe Liberman
- Division of Thoracic Surgery, Department of Surgery, University of Montréal, Montreal, QC, Canada
| | - Nuria Novoa
- Service of Thoracic Surgery, University Hospital, Salamanca, Spain
| | - Marco Scarci
- Department of Thoracic Surgery, University College London Hospital, London, UK
| | - Stefan Janik
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| |
Collapse
|
8
|
Lang-Lazdunski L, Tokaca N, Lal K, Steele J, Newsom-Davis T, Landau D, Spicer J, Popat S. 216PD Should radical surgery be performed in non-epithelioid malignant pleural mesothelioma? J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30489-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
9
|
|
10
|
Moser B, Fadel E, Fabre D, Keshavjee S, De Perrot M, Thomas P, Brioude G, Van Raemdonck D, Viskens S, Lang-Lazdunski L, Bille A, Weder W, Jungraithmayr W, Ruffini E, Guerrera F, Gómez De Antonio D, Liberman M, Novoa N, Scarci M, Janik S, Klepetko W. B-005SURGICAL THERAPY OF THYMIC TUMOURS WITH PLEURAL INVOLVEMENT: AN ESTS THYMIC WORKING GROUP SURVEY. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
11
|
Bayman N, Ardron D, Ashcroft L, Baldwin DR, Booton R, Darlison L, Edwards JG, Lang-Lazdunski L, Lester JF, Peake M, Rintoul RC, Snee M, Taylor P, Lunt C, Faivre-Finn C. Protocol for PIT: a phase III trial of prophylactic irradiation of tracts in patients with malignant pleural mesothelioma following invasive chest wall intervention. BMJ Open 2016; 6:e010589. [PMID: 26817643 PMCID: PMC4735163 DOI: 10.1136/bmjopen-2015-010589] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/02/2015] [Accepted: 12/07/2015] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Histological diagnosis of malignant mesothelioma requires an invasive procedure such as CT-guided needle biopsy, thoracoscopy, video-assisted thorascopic surgery (VATs) or thoracotomy. These invasive procedures encourage tumour cell seeding at the intervention site and patients can develop tumour nodules within the chest wall. In an effort to prevent nodules developing, it has been widespread practice across Europe to irradiate intervention sites postprocedure--a practice known as prophylactic irradiation of tracts (PIT). To date there has not been a suitably powered randomised trial to determine whether PIT is effective at reducing the risk of chest wall nodule development. METHODS AND ANALYSIS In this multicentre phase III randomised controlled superiority trial, 374 patients who can receive radiotherapy within 42 days of a chest wall intervention will be randomised to receive PIT or no PIT. Patients will be randomised on a 1:1 basis. Radiotherapy in the PIT arm will be 21 Gy in three fractions. Subsequent chemotherapy is given at the clinicians' discretion. A reduction in the incidence of chest wall nodules from 15% to 5% in favour of radiotherapy 6 months after randomisation would be clinically significant. All patients will be followed up for up to 2 years with monthly telephone contact and at least four outpatient visits in the first year. ETHICS AND DISSEMINATION PIT was approved by NRES Committee North West-Greater Manchester West (REC reference 12/NW/0249) and recruitment is currently on-going, the last patient is expected to be randomised by the end of 2015. The analysis of the primary end point, incidence of chest wall nodules 6 months after randomisation, is expected to be published in 2016 in a peer reviewed journal and results will also be presented at scientific meetings and summary results published online. A follow-up analysis is expected to be published in 2018. TRIAL REGISTRATION NUMBER ISRCTN04240319; NCT01604005; Pre-results.
Collapse
Affiliation(s)
- N Bayman
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - D Ardron
- The National Cancer Research Institute (NCRI) Consumer Liaison Group, London, UK
| | - L Ashcroft
- Manchester Academic Health Science Centre Trials Co-ordination Unit (MAHSC-CTU), The Christie NHS Foundation Trust, Manchester, UK
| | - D R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham City Hospital Campus, Nottingham, UK
| | - R Booton
- Respiratory and Allergy Research Group, Institute of Inflammation & Repair, The University of Manchester North West Lung Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - L Darlison
- Mesothelioma UK Charitable Trust, c/o Glenfield Hospital, Leicester, UK
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - J G Edwards
- Department of Cardiothoracic Surgery, Chesterman Unit, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust UK, Sheffield, UK
| | | | - J F Lester
- Department of Clinical Oncology, Velindre NHS Trust UK, Cardiff, UK
| | - M Peake
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
- National Cancer Intelligence Network, (NCIN), Public Health England, London, UK
| | - R C Rintoul
- Department of Thoracic Oncology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - M Snee
- Department of Clinical Oncology, Leeds Teaching Hospital NHS Trust, St James Hospital, Leeds, UK
| | - P Taylor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Department Pulmonary Oncology, Wythenshawe Hospital Manchester, Manchester, UK
| | - C Lunt
- Manchester Academic Health Science Centre Trials Co-ordination Unit (MAHSC-CTU), The Christie NHS Foundation Trust, Manchester, UK
| | - C Faivre-Finn
- The University of Manchester, Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester Cancer Research Centre (MCRC), Manchester, UK
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
| |
Collapse
|
12
|
Bayman N, Ardron D, Ashcroft L, Baldwin D, Booton R, Darlison L, Edwards J, Lang-Lazdunski L, Lester J, Peake M, Rintoul R, Snee M, Taylor P, Chappell B, Lunt C, Faivre-Finn C. 193 PIT: a phase III trial of Prophylactic Irradiation of Tracts in patients with malignant pleural mesothelioma following invasive chest wall intervention. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30210-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
Lang-Lazdunski L. Invited commentary. Ann Thorac Surg 2015; 99:481. [PMID: 25639393 DOI: 10.1016/j.athoracsur.2014.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 10/01/2014] [Accepted: 10/06/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Loic Lang-Lazdunski
- King's College London, Cardiothoracic Surgery, Guy's Hospital, Great Maze Pond, London, United Kingdom SE1 9RT.
| |
Collapse
|
14
|
Bayman N, Ardron D, Ashcroft L, Baldwin D, Booton R, Darlison L, Edwards J, Lang-Lazdunski L, Lester J, Peake M, Rintoul R, Snee M, Taylor P, Lunt C, Faivre-Finn C. 183: PIT: a phase III trial of prophylactic irradiation of tracts in patients with malignant pleural mesothelioma following invasive chest wall intervention. Lung Cancer 2015. [DOI: 10.1016/s0169-5002(15)50177-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
15
|
Youssefi P, Doyle T, Harrison-Phipps K, Pilling J, King J, Routledge T, Lang-Lazdunski L, Glover G, Langrish C, Ioannou N, Meadows C, Barrett N. Outcomes of thoracic surgical interventions on ECMO patients: A 4 year experience. Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.07.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
Lang-Lazdunski L. Surgery for malignant pleural mesothelioma: Why, when and what? Lung Cancer 2014; 84:103-9. [DOI: 10.1016/j.lungcan.2014.01.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/23/2014] [Accepted: 01/24/2014] [Indexed: 02/07/2023]
|
17
|
Okiror L, Coltart C, Bille A, Guile L, Pilling J, Harrison-Phipps K, Routledge T, Lang-Lazdunski L, Hemsley C, King J. Thoracotomy and decortication: impact of culture-positive empyema on the outcome of surgery. Eur J Cardiothorac Surg 2014; 46:901-6. [DOI: 10.1093/ejcts/ezu104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
18
|
Klabatsa A, Chicklore S, Barrington SF, Goh V, Lang-Lazdunski L, Cook GJR. The association of 18F-FDG PET/CT parameters with survival in malignant pleural mesothelioma. Eur J Nucl Med Mol Imaging 2014; 41:276-82. [PMID: 24057459 DOI: 10.1007/s00259-013-2561-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Malignant pleural mesothelioma (MPM) is a disease with poor prognosis despite multimodal therapy but there is variation in survival between patients. Prognostic information is therefore potentially valuable in managing patients, particularly in the context of clinical trials where patients could be stratified according to risk. Therefore we have evaluated the prognostic ability of parameters derived from baseline 2-[(18)F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT). METHODS In order to determine the relationships between metabolic activity and prognosis we reviewed all (18)F-FDG PET/CT scans used for pretreatment staging of MPM patients in our institution between January 2005 and December 2011 (n = 60) and measured standardised uptake values (SUV) including mean, maximum and peak values, metabolic tumour volume (MTV) and total lesion glycolysis (TLG). Overall survival (OS) or time to last censor was recorded, as well as histological subtypes. RESULTS Median follow-up was 12.7 months (1.9-60.9) and median OS was 14.1 months (1.9-54.9). By univariable analysis histological subtype (p = 0.013), TLG (p = 0.024) and MTV (p = 0.038) were significantly associated with OS and SUVmax was borderline (p = 0.051). On multivariable analysis histological subtype and TLG were associated with OS but at borderline statistical significance (p = 0.060 and 0.058, respectively). No statistically significant differences in any PET parameters were found between the epithelioid and non-epithelioid histological subtypes. CONCLUSION (18)F-FDG PET/CT parameters that take into account functional volume (MTV, TLG) show significant associations with survival in patients with MPM before adjusting for histological subtype and are worthy of further evaluation to determine their ability to stratify patients in clinical trials.
Collapse
Affiliation(s)
- Astero Klabatsa
- Department of Thoracic Oncology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | | | | |
Collapse
|
19
|
Bayman N, Ardron D, Ashcroft L, Baldwin D, Booton R, Darlison L, Edwards J, Lang-Lazdunski L, Lester J, Peake M, Rintoul R, Snee M, Taylor P, Lunt C, Faivre-Finn C. 216 PIT: A phase III trial of Prophylactic Irradiation of Tracts in patients with malignant pleural mesothelioma following invasive chest wall intervention. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70216-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Lüchtenborg M, Riaz S, Lim E, Page R, Baldwin D, Jakobsen E, Vedsted P, Lind M, Peake M, Mellemgaard A, Spicer J, Lang-Lazdunski L, Møller H. 187 Survival of small cell lung cancer patients undergoing lung resection in England 1998-2009. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
21
|
Lüchtenborg M, Riaz SP, Lim E, Page R, Baldwin DR, Jakobsen E, Vedsted P, Lind M, Peake MD, Mellemgaard A, Spicer J, Lang-Lazdunski L, Møller H. Survival of patients with small cell lung cancer undergoing lung resection in England, 1998-2009. Thorax 2013; 69:269-73. [PMID: 24172710 PMCID: PMC3932952 DOI: 10.1136/thoraxjnl-2013-203884] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Chemotherapy or chemoradiotherapy is the recommended treatment for small cell lung cancer (SCLC), except in stage I disease where clinical guidelines state there may be a role for surgery based on favourable outcomes in case series. Evidence supporting adjuvant chemotherapy in resected SCLC is limited but this is widely offered. Methods Data on 359 873 patients who were diagnosed with a first primary lung cancer in England between 1998 and 2009 were grouped according to histology (SCLC or non-SCLC (NSCLC)) and whether they underwent a surgical resection. We explored their survival using Kaplan–Meier analysis and Cox regression, adjusting for age, sex, comorbidity and socioeconomic status. Results The survival of 465 patients with resected SCLC was lower than patients with resected NSCLC (5-year survival 31% and 45%, respectively), but much higher than patients of either group who were not resected (3%). The difference between resected SCLC and NSCLC diminished with time after surgery. Survival was superior for the subgroup of 198 ‘elective’ SCLC cases where the diagnosis was most likely known before resection than for the subgroup of 267 ‘incidental’ cases where the SCLC diagnosis was likely to have been made after resection. Conclusions These data serve as a natural experiment testing the survival after surgical management of SCLC according to NSCLC principles. Patients with SCLC treated surgically for early stage disease may have survival outcomes that approach those of NSCLC, supporting the emerging clinical practice of offering surgical resection to selected patients with SCLC.
Collapse
Affiliation(s)
- Margreet Lüchtenborg
- Cancer Epidemiology and Population Health, King's Health Partners Cancer Centre, , London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Okiror L, Karenovics W, Bille A, Harrison-Phipps K, King J, Lang-Lazdunski L, Routledge T, Pilling J. 212 Contemporary single institution experience in the surgical treatment of patients with small cell lung cancer. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
23
|
Bliss JM, Coombes G, Darlison L, Edwards J, Entwisle J, Kilburn LS, Landau D, Lang-Lazdunski L, O'Brien M, O'Byrne K, Peto J, Senan S, Snee M, Spicer J, Tan C, Thomas G, Treasure T, Waller D. The MARS feasibility trial: conclusions not supported by data – Authors' reply. Lancet Oncol 2011. [DOI: 10.1016/s1470-2045(11)70308-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
24
|
Affiliation(s)
- Rebecca Tregunna
- Departments of Thoracic Surgery, Guy's Hospital, Great Maze Pond, London, England
| | | | | | | |
Collapse
|
25
|
Jethava Y, Alamelu J, Rangarajan S, Lang-Lazdunski L, van der Walt J, Fields P. Acquired Agranulocytosis and Factor XI Deficiency in Association With Thymoma. J Clin Oncol 2011; 29:e604-6. [DOI: 10.1200/jco.2010.34.3707] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Paul Fields
- Guy's and St Thomas' Hospital, London, United Kingdom
| |
Collapse
|
26
|
Treasure T, Lang-Lazdunski L, Waller D, Bliss JM, Tan C, Entwisle J, Snee M, O'Brien M, Thomas G, Senan S, O'Byrne K, Kilburn LS, Spicer J, Landau D, Edwards J, Coombes G, Darlison L, Peto J. Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study. Lancet Oncol 2011; 12:763-72. [PMID: 21723781 PMCID: PMC3148430 DOI: 10.1016/s1470-2045(11)70149-8] [Citation(s) in RCA: 474] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The effects of extra-pleural pneumonectomy (EPP) on survival and quality of life in patients with malignant pleural mesothelioma have, to our knowledge, not been assessed in a randomised trial. We aimed to assess the clinical outcomes of patients who were randomly assigned to EPP or no EPP in the context of trimodal therapy in the Mesothelioma and Radical Surgery (MARS) feasibility study. METHODS MARS was a multicentre randomised controlled trial in 12 UK hospitals. Patients aged 18 years or older who had pathologically confirmed mesothelioma and were deemed fit enough to undergo trimodal therapy were included. In a prerandomisation registration phase, all patients underwent induction platinum-based chemotherapy followed by clinical review. After further consent, patients were randomly assigned (1:1) to EPP followed by postoperative hemithorax irradiation or to no EPP. Randomisation was done centrally with computer-generated permuted blocks stratified by surgical centre. The main endpoints were feasibility of randomly assigning 50 patients in 1 year (results detailed in another report), proportion randomised who received treatment, proportion eligible (registered) who proceeded to randomisation, perioperative mortality, and quality of life. Patients and investigators were not masked to treatment allocation. This is the principal report of the MARS study; all patients have been recruited. Analyses were by intention to treat. This trial is registered, number ISRCTN95583524. FINDINGS Between Oct 1, 2005, and Nov 3, 2008, 112 patients were registered and 50 were subsequently randomly assigned: 24 to EPP and 26 to no EPP. The main reasons for not proceeding to randomisation were disease progression (33 patients), inoperability (five patients), and patient choice (19 patients). EPP was completed satisfactorily in 16 of 24 patients assigned to EPP; in five patients EPP was not started and in three patients it was abandoned. Two patients in the EPP group died within 30 days and a further patient died without leaving hospital. One patient in the no EPP group died perioperatively after receiving EPP off trial in a non-MARS centre. The hazard ratio [HR] for overall survival between the EPP and no EPP groups was 1·90 (95% CI 0·92-3·93; exact p=0·082), and after adjustment for sex, histological subtype, stage, and age at randomisation the HR was 2·75 (1·21-6·26; p=0·016). Median survival was 14·4 months (5·3-18·7) for the EPP group and 19·5 months (13·4 to time not yet reached) for the no EPP group. Of the 49 randomly assigned patients who consented to quality of life assessment (EPP n=23; no EPP n=26), 12 patients in the EPP group and 19 in the no EPP group completed the quality of life questionnaires. Although median quality of life scores were lower in the EPP group than the no EPP group, no significant differences between groups were reported in the quality of life analyses. There were ten serious adverse events reported in the EPP group and two in the no EPP group. INTERPRETATION In view of the high morbidity associated with EPP in this trial and in other non-randomised studies a larger study is not feasible. These data, although limited, suggest that radical surgery in the form of EPP within trimodal therapy offers no benefit and possibly harms patients. FUNDING Cancer Research UK (CRUK/04/003), the June Hancock Mesothelioma Research Fund, and Guy's and St Thomas' NHS Foundation Trust.
Collapse
Affiliation(s)
- Tom Treasure
- Department of Mathematics, Clinical Operational Research Unit, University College London, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Treasure T, Bliss J, Tan C, Entwisle J, Waller D, O'Brien M, Coombes G, Webster-Smith M, Kilburn L, Snee M, Thomas G, Darlison L, Lang-Lazdunski L, Peto J. 53 Principal results of the feasibility phase of the Mesothelioma and Radical Surgery trial (MARS-feasibility). Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Lang-Lazdunski L, Bille A, Ahmad S, Landau D. 126 Surgery of tumours invading the thoracic inlet (pancoast tumours): a contemporary experience. Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70126-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
30
|
Krieger L, Lal R, Lang-Lazdunski L, Harrison-Phipps K, Chowdhury F. 81 The presentation and management of thymic epithelial malignancies & the Guy's and St Thomas' hospital experience. Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70081-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
31
|
Belcher E, Hardwick T, Lal R, Marshall S, Spicer J, Lang-Lazdunski L. Induction chemotherapy, cytoreductive surgery and intraoperative hyperthermic pleural irrigation in patients with stage IVA thymoma. Interact Cardiovasc Thorac Surg 2010; 12:744-7. [DOI: 10.1510/icvts.2010.255307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
32
|
Werth SC, McLean E, Lang-Lazdunski L. Extended right pneumonectomy in an adult with a double aortic arch: a therapeutic dilemma. Interact Cardiovasc Thorac Surg 2010; 11:862-3. [DOI: 10.1510/icvts.2010.247221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
33
|
Lang-Lazdunski L. Invited Commentary. Ann Thorac Surg 2010; 90:188-9. [DOI: 10.1016/j.athoracsur.2010.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 04/02/2010] [Accepted: 04/09/2010] [Indexed: 10/19/2022]
|
34
|
Pilling J, Dartnell JA, Lang-Lazdunski L. Integrated Positron Emission Tomography-Computed Tomography Does Not Accurately Stage Intrathoracic Disease of Patients Undergoing Trimodality Therapy for Malignant Pleural Mesothelioma. Thorac Cardiovasc Surg 2010; 58:215-9. [DOI: 10.1055/s-0029-1241029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
35
|
Irshad S, Popat S, Shah RN, Burbridge S, Lal R, Lang-Lazdunski L, Viney Z, Marsden P, Barrington S, Spicer JF. A phase II study of sorafenib in malignant mesothelioma with pharmacodynamic imaging using 18fdg-PET. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
36
|
Tirabosco R, Lang-Lazdunski L, Diss TC, Amary MFC, Rodriguez-Justo M, Landau D, Lorenzi W, Flanagan AM. Clear cell sarcoma of the mediastinum. Ann Diagn Pathol 2009; 13:197-200. [DOI: 10.1016/j.anndiagpath.2008.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
37
|
Lang-Lazdunski L, Pilling J. Videothoracoscopic Excision of Mediastinal Tumors and Cysts Using the Harmonic Scalpel. Thorac Cardiovasc Surg 2008; 56:278-82. [DOI: 10.1055/s-2008-1038630] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
38
|
Miah A, Lang-Lazdunski L, Landau D. 52 Adjuvant radiotherapy (RT) following extra-pleural pneumonectomy (EPP)—the Guys & St Thomas experience. Lung Cancer 2007. [DOI: 10.1016/s0169-5002(07)70378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
39
|
Hickey EJ, Khan AA, Chambers JB, Lang-Lazdunski L. Constrictive Pericarditis After Left Extrapleural Pneumonectomy and Radiotherapy for Malignant Mesothelioma. J Thorac Oncol 2007; 2:673-5. [PMID: 17607128 DOI: 10.1097/jto.0b013e318070ccbf] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report the devastating complication of constrictive pericarditis after multimodality therapy including left extrapleural pneumonectomy for malignant pleural mesothelioma. The patient presented with progressive dyspnea, ascites, and peripheral edema 6 months after receiving adjuvant radiotherapy. A diagnosis of constrictive pericarditis was made late in the clinical course after exhaustive investigation to exclude primary disease recurrence. Pericardial decortication was subsequently undertaken 12 months after the initial surgery, but the patient died of multi-organ failure. Our experience, combined with a review of the available literature, leads us to advise a low level of suspicion and early operation to relieve cardiac constriction. Furthermore, these complications emphasize the importance of trials such as the Mesothelioma and Radical Surgery (MARS) study.
Collapse
|
40
|
Hickey EJ, Khan A, Anderson D, Lang-Lazdunski L. Complete vascular ring presenting in adulthood: an unusual management dilemma. J Thorac Cardiovasc Surg 2007; 134:235-6. [PMID: 17599517 DOI: 10.1016/j.jtcvs.2007.01.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Accepted: 01/31/2007] [Indexed: 11/16/2022]
Affiliation(s)
- Edward J Hickey
- Department of Thoracic Surgery, Guy's Hospital, King's College London, London, United Kingdom
| | | | | | | |
Collapse
|
41
|
Khan AA, Tambiah J, Cane P, Lang-Lazdunski L. Prolonged survival in a patient with recurrent pulmonary metastases secondary to mucinous cystadenocarcinoma of the appendix with pseudomyxomatous peritonei. Ann Thorac Surg 2007; 83:1893-4. [PMID: 17462430 DOI: 10.1016/j.athoracsur.2006.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 11/10/2006] [Accepted: 12/04/2006] [Indexed: 11/16/2022]
Abstract
We report a 65-year-old man presenting with recurrent pulmonary metastases 20 years after an appendectomy for mucinous cystadenocarcinoma with pseudomyxomatous peritonei. He underwent bilateral staged metastatectomies for metastases 7 years after the diagnosis and further metastasectomy after a recent recurrence. This is a rare case of recurrent pulmonary metastatic mucinous cystadenocarcinoma, and despite poor prognosis and nondefinitive initial treatment, this patient remains alive and well 20 years later.
Collapse
Affiliation(s)
- Aftab A Khan
- Department of Thoracic Surgery, Guys Hospital, Kings College London, London, United Kingdom.
| | | | | | | |
Collapse
|
42
|
Pai V, Gangoli S, Tan C, Rankin S, Utley M, Cameron R, Lang-Lazdunski L, Treasure T. How best to manage the space after pneumonectomy? Theory and experience but no evidence. Heart Lung Circ 2007; 16:103-6. [PMID: 17314067 DOI: 10.1016/j.hlc.2006.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2006] [Revised: 10/31/2006] [Accepted: 11/04/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We set out to find a policy for the management of the pneumonectomy space which would minimise risk and be acceptable to all the surgeons. We believe this will reduce opportunities for error, be welcomed by nursing staff, and improve adherence to protocols. METHODS We sought evidence in the scientific and educational literature. Finding no sure guidance, we audited our own experience of two policies, with the emphasis on minimising risk. RESULTS There was no evidence from randomised trials. There was no cohesive advice in the text books. Our data indicated that it was improbable that randomised controlled trial (RCT) would have the power to find the evidence. Unable to establish the best strategy, we chose what appeared to be the lowest risk management policy. CONCLUSIONS It is instructive that such a fundamental question should be unanswered. We have adopted a low risk and well established strategy--an unclamped underwater seal drain--but have no evidence base other than clinical experience. This is illustrative of much of what we do in clinical surgical practice. Avoiding major risk is often more important than proving small differences in benefit.
Collapse
Affiliation(s)
- Vasudev Pai
- Guy's Hospital, Department of Thoracic Surgery, St. Thomas's Street, SE1 9RT London, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Affiliation(s)
| | - John E Pilling
- Department of Thoracic Surgery, Guy's Hospital, London SE1 9RT
| |
Collapse
|
44
|
Affiliation(s)
- M J Steward
- Department of Cardiology, Cardiothoracic Centre, St. Thomas' Hospital, London, UK.
| | | | | | | |
Collapse
|
45
|
Steward MJ, D'Cruz DP, Lang-Lazdunski L, Chambers J. Fever, haemoptysis and a mass in the heart. J R Soc Med 2007. [DOI: 10.1258/jrsm.100.2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
46
|
Lang-Lazdunski L, Landau D, Herbert A, Cane P, Staples E, Barrington S, Rankin S. 186 Impact of integrated PET-CT on the selection of patients with malignant pleural mesothelioma for radical surgery (extrapleural pneumonectomy). Lung Cancer 2006. [DOI: 10.1016/s0169-5002(07)70262-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
47
|
Hunt I, Lang-Lazdunski L. Is Median Sternotomy an Appropriate Approach to Right Extrapleural Pneumonectomy for Mesothelioma? Ann Thorac Surg 2006; 82:767; author reply 767. [PMID: 16863819 DOI: 10.1016/j.athoracsur.2005.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 10/20/2005] [Accepted: 11/07/2005] [Indexed: 11/15/2022]
|
48
|
Hunt I, Rankin SC, Lang-Lazdunski L. Combined lung resection and transdiaphragmatic adrenalectomy in patients with non-small cell lung cancer and homolateral solitary adrenal metastasis. Eur J Cardiothorac Surg 2006; 30:194-5. [PMID: 16725337 DOI: 10.1016/j.ejcts.2006.03.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 02/10/2006] [Accepted: 03/29/2006] [Indexed: 10/24/2022] Open
Abstract
Surgery may offer a long-term survival benefit to a small proportion of patients with operable non-small cell lung cancer (NSCLC) and solitary adrenal metastasis. Several approaches to lung resection with a separate open or laparoscopic adrenalectomy have been advocated. We describe a technique that allows a single incision, single operation through a transdiaphragmatic approach to the ipsilateral adrenal gland following a standard lung resection through a postero-lateral thoracotomy. By using this approach, along with the harmonic scalpel to aid adrenal dissection, both lobectomy and adrenalectomy can be carried out safely and effectively with minimal perioperative and postoperative morbidity.
Collapse
Affiliation(s)
- Ian Hunt
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | | | | |
Collapse
|
49
|
Affiliation(s)
- Parag Jaiswal
- Department of Thoracic Surgery, Guy's Hospital, London, UK
| | | | | | | |
Collapse
|
50
|
Alphonso N, Tan C, Utley M, Cameron R, Dussek J, Lang-Lazdunski L, Treasure T. A prospective randomized controlled trial of suction versus non-suction to the under-water seal drains following lung resection. Eur J Cardiothorac Surg 2005; 27:391-4. [PMID: 15740944 DOI: 10.1016/j.ejcts.2004.12.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Revised: 11/29/2004] [Accepted: 12/06/2004] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Practice varies as to whether or not suction is applied to under-water seal drains following lung surgery. We tested the null hypothesis that there is no difference with respect to air leak duration. METHODS Patients undergoing thoracotomy or video assisted thoracoscopic surgery for lobectomy or wedge resection had either low-pressure suction or no suction applied to their underwater seal bottles postoperatively. Patients were allocated using minimization, a method of unbiased allocation ensuring balance between the arms of a trial with respect to known or suspected confounding factors. The trial was powered for duration of air leak. If an air leak persisted on the 7th post-operative day, the surgeon determined further management. Kaplan-Meier survival analysis of air leak duration and a log rank test were performed on an intention-to-treat basis, with observations censored at 144h (6 complete days). RESULTS Of the 254 patients that entered the trial, data were available for analysis for 239 (123 no-suction and 116 suction). There was no significant difference in the cumulative persistence of air leaks between the two groups (P=0.62) and inspection of the Kaplan-Meier curves suggests that any difference is negligible. CONCLUSIONS Applying suction to the underwater seal drains following lung surgery makes no difference in terms of air leak duration. In the light of this finding we have adopted a uniform policy of no suction being applied to the underwater seal, from the time of surgery, unless a specific clinical judgment is made to use it. The anticipated gains are that this will reduce work and cost and aid mobilization.
Collapse
|