Extrapleural pneumonectomy for malignant pleural mesothelioma

Area of Science:

• Thoracic Surgery
• Surgical Oncology

Background:

• Extrapleural pneumonectomy (EP) was initially developed for extensive lung and pleural space infections.
• Over two decades, EP has been refined for treating advanced malignant pleural mesothelioma, significantly reducing mortality.
• Current low mortality rates enable its application in advanced lung cancer and thymoma.

Purpose of the Study:

• To detail the modified extrapleural pneumonectomy technique for thoracic malignancies.
• To highlight the advancements leading to reduced mortality and expanded indications for EP.
• To present a 20-year experience from Brigham and Women's Hospital/Dana Farber Cancer Institute.

Main Methods:

• The EP technique involves five key steps: pleural exposure, dissection, pulmonary vessel/bronchus control with lymphadenectomy, en bloc resection, and reconstruction.
• Patient selection and operative refinements, including a 3-hour operative time, are crucial.
• This approach is based on extensive experience with malignant pleural mesothelioma.

Main Results:

• The modified EP technique has achieved a 3.4% mortality rate.
• Complication rates remain significant, with 60% experiencing minor or major complications.
• Reduced operative time, refined techniques, and improved patient selection contribute to lower mortality.

Conclusions:

• Extrapleural pneumonectomy is a complex but effective procedure for advanced thoracic cancers.
• Refinements in technique and patient selection have drastically improved outcomes.
• The procedure is now applicable to a broader range of locally advanced thoracic malignancies.