Lee Dong-Seok, Carollo Andrea, Alpert Naomi, Taioli Emanuela, Flores Raja
Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029, USA.
Cancers (Basel). 2021 Mar 3;13(5):1068. doi: 10.3390/cancers13051068.
Surgery is a mainstay of treatment allowing for debulking of tumor and expansion of the lung for improvement in median survival and quality of life for patients with malignant pleural mesothelioma (MPM). Although optimal surgical technique remains open for debate-extrapleural pneumonectomy (EPP) vs. pleurectomy/decortication (P/D)-minimally invasive surgery (VATS-P/D) remains underutilized in the management of MPM. We examined whether VATS-P/D is a feasible alternative to EPP and P/D. We evaluated the New York Statewide Planning and Research Cooperative System (SPARCS) from 2007-2017 to assess the short-term complications of EPP vs. P/D, including a subanalysis of open P/D vs. VATS-P/D. There were 331 patients with open surgery; 269 with P/D and 62 with EPP. There were 384 patients with P/D; 269 were open and 115 VATS. Rates of any complication were similar between EPP and P/D patients, but EPP had significantly higher rates of cardiovascular complications. After adjusting for confounders, those with a VATS approach were less likely to have any complication, compared to an open approach and significantly less likely to have a pulmonary complication. VATS-P/D remains a viable alternative to radical surgery in MPM patients allowing for improved short-term outcomes.
手术是治疗恶性胸膜间皮瘤（MPM）的主要手段，可实现肿瘤减瘤及肺扩张，从而改善患者的中位生存期和生活质量。尽管最佳手术技术仍存在争议——全胸膜外肺切除术（EPP）与胸膜切除术/纤维板剥脱术（P/D）——但在MPM的治疗中，微创手术（VATS-P/D）的应用仍未得到充分利用。我们研究了VATS-P/D是否是EPP和P/D的可行替代方案。我们评估了2007年至2017年纽约州全州规划与研究合作系统（SPARCS），以评估EPP与P/D的短期并发症，包括对开放P/D与VATS-P/D的亚分析。有331例患者接受开放手术；269例接受P/D，62例接受EPP。有384例患者接受P/D；269例为开放手术，115例为VATS手术。EPP和P/D患者的任何并发症发生率相似，但EPP的心血管并发症发生率显著更高。在对混杂因素进行调整后，与开放手术相比，采用VATS手术的患者发生任何并发症的可能性较小，发生肺部并发症的可能性也显著较小。对于MPM患者，VATS-P/D仍然是根治性手术的可行替代方案，可改善短期预后。
