Second Department of Surgery (Chest Surgery), University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu, 807-8555, Japan.
Gen Thorac Cardiovasc Surg. 2021 Sep;69(9):1320-1325. doi: 10.1007/s11748-021-01643-z. Epub 2021 May 24.
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.
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.
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.
Non-incisional pleurectomy/decortication is a fast and feasible technique to achieve en bloc macroscopic complete resection for malignant pleural mesothelioma.
根治性胸膜切除术/剥脱术一直被优选用于恶性胸膜间皮瘤的治疗。然而，在胸膜切除术/剥脱术中进行内脏层胸膜切除术存在技术挑战。为了进行内脏层胸膜切除术，通常需要在脏层胸膜和肺实质之间切开胸膜，这可能导致肿瘤扩散，并且可能无法整块切除整个胸膜。为了克服这些潜在的缺点，我们开发了一种新的手术技术，无需进行任何胸膜切开术（非切开式胸膜切除术/剥脱术），以实现整块切除整个胸膜。
回顾性分析了 2017 年 1 月至 2020 年 12 月期间在我院接受非切开式胸膜切除术/剥脱术治疗恶性胸膜间皮瘤的 36 例连续患者的资料，以评估该技术的可行性。
31 例（86.1%）患者通过非切开式胸膜切除术/剥脱术实现了大体完全切除。在大多数患者中（n=29），整块切除了整个胸膜（10 例无胸膜撕裂，19 例有部分胸膜撕裂）。与传统胸膜切除术/剥脱术相比，非切开式胸膜切除术/剥脱术的总手术时间和内脏层胸膜切除时间明显缩短（中位数分别为 350 分钟与 506 分钟[P=0.011]，43 分钟与 97 分钟[P<0.001]）。在接受非切开式胸膜切除术/剥脱术的 36 例患者中，术后并发症发生在 13 例患者（36.1%），1 例患者术后第 95 天因残留肿瘤的侵袭性肿瘤进展而死亡。
非切开式胸膜切除术/剥脱术是一种快速可行的技术，可整块切除肉眼恶性胸膜间皮瘤。
