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Non-incisional pleurectomy/decortication for malignant pleural mesothelioma

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Abstract

Objective

Pleurectomy/decortication has been preferably employed as a curative-intent surgery for malignant pleural mesothelioma. However, visceral pleurectomy during pleurectomy/decortication provides technical challenges. For visceral pleurectomy, pleural incisions are commonly made to create a dissection plane between the visceral pleura and the lung parenchyma, which may cause tumor dissemination and may not allow en bloc complete resection of the entire pleura. To overcome such potential disadvantages, we have developed a novel surgical technique without any pleural incision (non-incisional pleurectomy/decortication) to achieve en bloc removal of the entire pleura.

Methods

A total of 36 consecutive patients who underwent non-incisional pleurectomy/decortication for malignant pleural mesothelioma from January 2017 through December 2020 in our institute were retrospectively reviewed to assess the feasibility.

Results

Macroscopic complete resection was achieved in 31 patients (86.1%) with non-incisional pleurectomy/decortication. In the majority of patients (n = 29), en bloc complete resection of the entire pleura was achieved (without pleural laceration in 10 and with some pleural laceration in 19 patients). The total operation time and the duration of visceral pleurectomy were significantly shorter as compared with those for conventional pleurectomy/decortication (median, 350 versus 506 min [P = 0.011], and 43 versus 97 min [P < 0.001], respectively). Among 36 patients who underwent non-incisional pleurectomy/decortication, postoperative complications developed in 13 patients (36.1%), and one patient died on the postoperative day 95 caused by aggressive tumor progression of residual tumor.

Conclusions

Non-incisional pleurectomy/decortication is a fast and feasible technique to achieve en bloc macroscopic complete resection for malignant pleural mesothelioma.

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Acknowledgements

This work was supported in part by the Japan Society for the Promotion of Science (JSPS) [Grants-in-Aid for Scientific Research Grant nos. 16K10697, 16H01747]. We thank all surgeons and physicians working for the MPM project in the University Hospital, the University of Occupational and Environmental Health, Japan.

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Authors and Affiliations

  1. Second Department of Surgery (Chest Surgery), University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu, 807-8555, Japan

    Fumihiro Tanaka, Masaru Takenaka, Naoko Imanishi, Ayako Hirai, Masatoshi Kanayama, Masataka Mori, Hiroki Matsumiya, Akihiro Taira, Shinji Shinohara & Koji Kuroda

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  1. Fumihiro Tanaka
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  2. Masaru Takenaka
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  3. Naoko Imanishi
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  6. Masataka Mori
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Correspondence to Fumihiro Tanaka.

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11748_2021_1643_MOESM2_ESM.pdf

Supplementary Fig. 1a Overall survival (OS) after non-incisional pleurectomy decortication (P/D). Supplementary Fig. 1b Overall survival (OS) after non-incisional pleurectomy decortication (P/D): comparison between patients with epithelioid malignant pleural mesothelioma (MPM) and those with non-epithelioid MPM. Supplementary Fig. 1c Overall survival (OS) after pleurectomy/decortication (P/D) for malignant pleural mesothelioma (MPM): comparison between non-incisional P/D and conventional P/D. Supplementary Fig. 1d Overall survival (OS) after pleurectomy/decortication (P/D) for epithelioid-type malignant pleural mesothelioma (MPM): comparison between non-incisional P/D and conventional P/D. Supplementary Fig. 2a Relapse-free survival (RFS) after non-incisional pleurectomy decortication (P/D) 1. Supplementary Fig. 2b Relapse-free survival (RFS) after non-incisional pleurectomy decortication (P/D): comparison between patients with epithelioid malignant pleural mesothelioma (MPM) and those with non-epithelioid MPM. Supplementary Fig. 2c Relapse-free survival (RFS) after pleurectomy/decortication (P/D) for malignant pleural mesothelioma (MPM): comparison between non-incisional P/D and conventional P/D. Supplementary Fig. 2d Relapse-free survival (RFS) after pleurectomy/decortication (P/D) for epithelioid-type malignant pleural mesothelioma (MPM): comparison between non-incisional P/D and conventional P/D (PDF 203 kb)

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Tanaka, F., Takenaka, M., Imanishi, N. et al. Non-incisional pleurectomy/decortication for malignant pleural mesothelioma. Gen Thorac Cardiovasc Surg 69, 1320–1325 (2021). https://doi.org/10.1007/s11748-021-01643-z

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