Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
Respiration. 2021;100(12):1165-1173. doi: 10.1159/000517334. Epub 2021 Aug 12.
Lung-sparing cytoreductive surgery by extended pleurectomy and decortication (EPD) in combination with hyperthermic intrathoracic chemoperfusion (HITOC) forms a promising treatment strategy for malignant pleural mesothelioma and recurrent pleural thymic malignancies.
The objective of this study was to scrutinize the surgical procedure and perioperative patient management with emphasis on perioperative morbidity and local tumor control.
In 2014, a standardized EPD and HITOC procedure was implemented at the Thoraxklinik Heidelberg. This retrospective analysis included clinical data of consecutive patients with pleural mesothelioma and pleural metastasized malignancies treated by EPD and HITOC. The surgical procedure, perioperative management, lung function data, and progression-free survival (PFS) were analyzed.
In the time range between April 2, 2014 and July 2018, 76 patients with pleural malignancies have been treated with EPD and HITOC, and were analyzed retrospectively. It included 61 patients with pleural mesothelioma and 15 patients with pleural metastases of thymic malignancies (12), non-small cell lung cancer (1), colorectal carcinoma (1), and sarcoma (1). Perioperative morbidity following EPD and HITOC treatments represented 23.7% of overall malignancies, while 30- and 90-day mortality were 0 and 1.3%, respectively. Median PFS lasted 18.4 months for mesothelioma and 72.2 months for thymic malignancies.
Combining EPD with HITOC can be performed in patients with either pleural mesothelioma or pleural metastases resulting in low perioperative morbidity and mortality as well as remarkable local tumor control.
肺保护性细胞减灭术联合胸膜外全肺切除术和高温胸腔内化疗（HITOC）是治疗恶性胸膜间皮瘤和复发性胸膜胸腺癌的一种很有前途的治疗策略。
本研究旨在仔细研究手术过程和围手术期患者管理，重点关注围手术期发病率和局部肿瘤控制。
2014 年，海德堡胸科医院实施了标准化的 EPD 和 HITOC 程序。本回顾性分析包括通过 EPD 和 HITOC 治疗的胸膜间皮瘤和胸膜转移恶性肿瘤连续患者的临床数据。分析了手术过程、围手术期管理、肺功能数据和无进展生存期（PFS）。
在 2014 年 4 月 2 日至 2018 年 7 月期间，76 例胸膜恶性肿瘤患者接受了 EPD 和 HITOC 治疗，并进行了回顾性分析。其中包括 61 例胸膜间皮瘤患者和 15 例胸腺恶性肿瘤胸膜转移患者（12 例）、非小细胞肺癌（1 例）、结直肠癌（1 例）和肉瘤（1 例）。EPD 和 HITOC 治疗后的围手术期发病率占所有恶性肿瘤的 23.7%，30 天和 90 天死亡率分别为 0 和 1.3%。间皮瘤的中位 PFS 为 18.4 个月，胸腺癌为 72.2 个月。
EPD 联合 HITOC 可用于治疗胸膜间皮瘤或胸膜转移患者，可降低围手术期发病率和死亡率，并获得显著的局部肿瘤控制效果。
