Department of Thoracic Surgery, Northern Hospital, Melbourne, Vic, Australia.
Department of Thoracic Surgery, Northern Hospital, Melbourne, Vic, Australia.
Heart Lung Circ. 2023 May;32(5):587-595. doi: 10.1016/j.hlc.2023.02.004. Epub 2023 Mar 14.
Malignant pleural mesothelioma (MPM) is an aggressive, almost universally fatal cancer with limited therapeutic options. Despite efforts, a real breakthrough in treatment and outcomes has been elusive. Pleural effusion with significant breathlessness and pain is the most typical presentation of individuals with MPM. Although thoracentesis provides relief of breathlessness, most such pleural effusions recur rapidly, and a definitive procedure is often required to prevent a recurrence. Unfortunately, the optimal treatment modality for individuals with recurrent MPM-related effusion is unclear, and considerable variation exists in practice. In addition, non-expandable lung is common in pleural effusions due to MPM and makes effective palliation of symptoms more difficult. This review delves into the latest advances in the available management options (both surgical and non-surgical) for dealing with pleural effusion and non-expandable lung related to MPM. We discuss factors that determine the choice of definitive procedures that need to be tailored to the individual patient.
恶性胸膜间皮瘤(MPM)是一种侵袭性的、几乎普遍致命的癌症,治疗选择有限。尽管已经做出了努力,但在治疗和结果方面仍未取得真正的突破。有明显呼吸困难和疼痛的胸腔积液是 MPM 患者最典型的表现。虽然胸腔穿刺术可以缓解呼吸困难,但大多数此类胸腔积液会迅速复发,通常需要进行确定性手术以防止复发。不幸的是,对于复发性 MPM 相关胸腔积液患者,最佳治疗方式尚不清楚,而且在实践中存在很大差异。此外,由于 MPM 导致胸腔积液中常见不可扩张的肺,这使得有效缓解症状更加困难。本文深入探讨了处理与 MPM 相关胸腔积液和不可扩张肺的现有管理选择(包括手术和非手术)的最新进展。我们讨论了决定需要个体化定制的确定性手术选择的因素。