Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia.
Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
BMJ Open. 2024 May 16;14(5):e078125. doi: 10.1136/bmjopen-2023-078125.
Extrapleural pneumonectomy (EPP) and extended pleurectomy/decortication (ePD) are surgical cytoreductive techniques aimed at achieving macroscopic resection in malignant pleural tumours such as pleural mesothelioma, non-mesothelioma pleural malignancies such as thymoma and sarcoma, and rarely for pleural tuberculosis, in a more limited fashion. Despite extensive studies on both surgical techniques and consequences, a significant knowledge gap remains regarding how best to approach the perioperative anaesthesia challenges for EPP and ePD.It is unknown if the risk stratification processes for such surgeries are standardised or what types of functional and dynamic cardiac and pulmonary tests are employed preoperatively to assist in the perioperative risk stratification. Further, it is unknown whether the types of anaesthesia and analgesia techniques employed, and the types of haemodynamic monitoring tools used, impact on outcomes. It is also unknown whether individualised haemodynamic protocols are used to guide the rational use of fluids, vasoactive drugs and inotropes.Finally, there is a dearth of evidence regarding how best to monitor these patients postoperatively or what the most effective enhanced recovery protocols are to best mitigate postoperative complications and accelerate hospital discharge. To increase our knowledge of the perioperative and anaesthetic treatment for patients undergoing EPP/ePD, this scoping review attempts to synthesise the literature and identify these knowledge gaps.
This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review Protocols methodology. Electronic databases, OVID Medline, EMBASE and the Cochrane Library, will be systematically searched for relevant literature corresponding to EPP or ePD and perioperative or anaesthetic management. Data will be analysed and summarised descriptively and organised according to the three perioperative stages: preoperative, intraoperative and postoperative factors in clinical care.
Ethics approval was not required. The findings will be disseminated through professional networks, conference presentations and publications in scientific journals.
胸膜外全肺切除术（EPP）和广泛胸膜切除术/剥脱术（ePD）是旨在实现恶性胸膜肿瘤（如胸膜间皮瘤）、非间皮瘤胸膜恶性肿瘤（如胸腺瘤和肉瘤），以及罕见的胸膜结核的大体切除的外科细胞减灭术，其应用方式更为局限。尽管对这两种手术技术和后果进行了广泛的研究，但对于 EPP 和 ePD 的围手术期麻醉挑战，如何最好地处理仍然存在显著的知识空白。尚不清楚这些手术的风险分层过程是否标准化，或者术前采用哪些类型的功能和动态心脏和肺功能检查来协助围手术期风险分层。此外，尚不清楚所采用的麻醉和镇痛技术类型以及使用的血流动力学监测工具类型是否会对结果产生影响。也不清楚是否使用个体化的血流动力学方案来指导液体、血管活性药物和正性肌力药物的合理使用。最后，关于如何最好地监测这些患者术后以及最佳减轻术后并发症和加速出院的最有效的强化康复方案，缺乏证据。为了增加我们对接受 EPP/ePD 手术的患者围手术期和麻醉治疗的了解，本范围综述试图综合文献并确定这些知识空白。
本范围综述将按照系统评价和荟萃分析扩展的首选报告项目中针对范围综述方案的方法进行。将系统地在电子数据库（OVID Medline、EMBASE 和 Cochrane 图书馆）中搜索与 EPP 或 ePD 以及围手术期或麻醉管理相关的文献。将对数据进行分析和描述性总结，并根据临床护理的三个围手术期阶段进行组织：术前、术中及术后因素。
无需伦理批准。研究结果将通过专业网络、会议演示和科学期刊发表进行传播。
