This randomized controlled trial compared VATS partial pleurectomy (VAT-PP) to talc pleurodesis in patients with malignant mesothelioma and a pleural effusion, evaluating overall survival. VAT-PP was associated with significantly greater surgical complications, a higher rate of respiratory complications and prolonged air leak, and a significantly lo
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Efficacy and cost of video-assisted thoracoscopic partial pleurectomy versus talc pleurodesis in patients with malignant pleural mesothelioma (MesoVATS): an open-label, randomised, controlled trial
September 25, 2014
Extrapleural Pneumonectomy in the Treatment of Epithelioid Malignant Pleural Mesothelioma: Novel Prognostic Implications of Combined N1 and N2 Nodal Involvement Based on Experience in 529 Patients
September 16, 2014
This retrospective review of pts undergoing complete resection by extrapleural pneumonectomy 1998-2011 for malignant mesothelioma focused on stage predictors of survival. Surgical mortality was 5%. Overall survival at 5 years was 14%, and median survival was 18 mos. Median survival for N1 or N2 disease was 17 and 13 mos, respectively. Nodal stag
August 11, 2014
Data from 6 cohort studies were evaluated to assess the ongoing risk of mesothelioma more than 40 years after initial environmental exposure to asbestos. Among over 22,000 of those exposed, 707 cases of pleural mesothelioma were diagnosed. The rate and risk increased until 45 years after exposure, then the rate of increase tapered off somewhat.
Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score
August 7, 2014
The authors developed and validated a survival predictive score for patients with malignant pleural effusion using 3 large international cohorts of patients. The LENT score is based on LDH level, ECOG performance status, neutrophil to lymphocyte ratio, and tumor type. Low risk patients had a median survival of 319 days, moderate risk group survival
July 31, 2014
Using a retrospective analysis of pts undergoing VATS for suspected pleural malignancy, the authors assessed the utility of CT in diagnosing pleural malignancy. Of 370 pts studied, 211 had a pleural malignancy diagnosis established by biopsy. The sensitivity of CT for detecting malignancy was 68%, and the negative predictive value was 65%. CT alon
July 16, 2014
Spontaneous pneumothorax is often treated with a large bore chest tube placement and hospitalization. This article presents a reproducible education model for treating spontaneous pneumothorax with a percutaneous catheter and water seal/collection device.
May 29, 2014
This multicenter retrospective review included 518 pts from 9 centers who underwent EPP from 2000 to 2010. Half the pts received induction chemotherapy, and nearly three-quarters of the patients received postoperative adjuvant therapy, primarily chemotherapy. The major surgical complication rate was 26% and 90 day mortality was 6.9%. 3-year surviv
March 15, 2014
The authors evaluated the impact of small (<10mm) pleural effusion on outcomes in patients with NSCLC. Of over 2000 pts, minimal PE was present in 13%. It was more common in patients with more advanced stages. Minimal PE was associated with decreased median survival (7.7 vs 17.7 mos) after adjustment for other prognostic variables. The impact
Does Surgery Improve Survival of Patients with Malignant Pleural Mesothelioma?: A Multicenter Retrospective Analysis of 1365 Consecutive Patients
February 24, 2014
A group of 1365 pts from 6 institutions was retrospectively reviewed for outcomes after palliative treatment, chemotherapy alone, pleurectomy/decortication (P/D), or extrapleural pneumonectomy (EPP). Multivariable analysis identified age
February 11, 2014
Dual incision thoracoscopic (DIT) decortication for stage 2 fibrinopurulent effusion is a further reduction in the invasiveness of thoracoscopy. DIT decortication is less invasive in a patient who is already morbid with infection, and the limited incisions or ports further reduce nerve injury in a relatively crowded rib space.