Table 2.
A textual analysis of the operative descriptions for lung sparing extirpative surgery in its various forms. Where a study included more than one form of surgery (as determined by the authors, for example the Mayo Clinic report of Schipper et al.) these are described separately. The studies are in date order of reporting
| Author | From | Until | Series* | Stated surgical extent and intent† | Pericardium resected | Diaphragm resected |
|---|---|---|---|---|---|---|
| Law 198433 | 1971 | 1980 | 28/150 | Non-radical parietal pleurectomy and decortication of the lung, removing the bulk of the tumour as discussed by Butchart | ||
| Achatzy 198932 | 1969 | 1985 | 48/245 | Total pleurectomy‡ | 1 | |
| Achatzy 198932 | 1969 | 1985 | 72/245 | Partial pleurectomy | ||
| Ball 199030 | 1981 | 1985 | 13/35 | … radical surgery, i.e. pleurectomy with attempted removal of all macroscopic disease | ||
| Harvey 199031 | 1965 | 1988 | 9/94 | … palliative surgery consisting of decortication and pleurectomy | 1 | |
| Brancatisano 199128 | 1984 | 1989 | 45/45 | … subtotal parietal pleurectomy … costal parietal pleura was resected sparing the mediastinal and diaphragmatic pleurae | ||
| Branscheid 199129 | 1978 | 1989 | 82/301 | … palliative decortication … | ||
| Allen 199427 | 1958 | 1993 | 56/96 | Pleurectomy§ | ||
| Lee 199525 | 1986 | 1993 | 15/15 | At thoracotomy, most gross disease was resected in areas involving the pericardium, parietal, visceral, and mediastinal pleura. Disease involving the surface of the diaphragm underwent resection, but frank invasion of the diaphragm or chest wall precluded a complete resection | ||
| Sauter 199526 | 1988 | 1992 | 20/20 | An extrapleural stripping of the tumor was performed from the apex of the lung to the diaphragm and along the pericardium in an attempt to remove all gross disease. The phrenic nerve was preserved if necessary on an isthmus of pericardium. While clearing of the chest wall and much of the lung was usually possible, in many cases gross disease was left behind on the diaphragm and/or the mediastinum | ||
| Colleoni 199624 | 1990 | 1994 | 20/20 | A resection of all gross tumor with minimal residual disease (defined as no nodules >1 cm in diameter and 0.5 cm in thickness was possible in only seven patients; 13 cases had gross residual disease | ||
| Ceresoli 200123 | 1986 | 1989 | 54/121 | Surgical intervention was palliative pleurectomy with extensive debulking of tumor in all cases | ||
| Aziz 200221 | 1989 | 1999 | 47/302 | A lesser procedure such as decortication/pleurectomy was considered for locally extensive disease … | ||
| Lee 200222 | 1986 | 1993 | 15/15 | A complete extrapleural dissection was performed on all patients. Occasionally, patients with locally extensive disease through the endothoracic fascia received limited en bloc chest wall resection. All efforts were made to avoid entry into the peritoneum. Patients underwent complete visceral pleurectomy, including clean dissection of the pulmonary artery and hilar structures | 8 | |
| De Vries 200317 | 1976 | 2001 | 29/46 | Although an attempt was made to remove all macroscopic visible tumor, the pleurectomies were usually incomplete, especially over the diaphragmatic and mediastinal surfaces | ||
| Monneuse 200318 | 1990 | 2000 | 16/24 | The extent of surgery was tailored according to the disease and the patient's condition. Maximal attempts were made to remove all macroscopic tumour | ||
| Phillips 200319 | 1989 | 1999 | 15/70 | Pleurectomy confined to the parietal pleura | ||
| Yom 200320 | 2000 | 2001 | 8/9 | Pleurectomy and decortication | ||
| Colaut 200415 | 1985 | 2002 | 40 | Surgical pleurectomy was preformed to remove all gross tumour or to obtain significant debulking. Partial or total pleurectomy of the visceral pleura depended on the extent of the tumour | ||
| Matzi 200416 | 1993 | 2003 | 34 | … debulking and decortication … All gross disease was removed, leaving as little residual tumour as possible | 2 | |
| Clarke 200614 | 1989 | 1999 | 100 | Decortication of the tumor was carried out as completely as possible, removing the parietal pleura and any tumor on the surface of the lung, and taking care to open all the fissures | ||
| Lucchi 200712 | 1999 | 2004 | 49 | … P/D consisting of the removal of the parietal and mediastinal pleura of the involved areas of the visceral pleura, with minimal resection of the lung if necessary. In case of minimal involvement of the pericardium and diaphragm, they were resected and sutured; however, they were never replaced with a mesh as for the radical P/D … | ||
| Okada 200813 | 1986 | 2006 | 34/87 | P/D was defined as total removal of the parietal pleura, visceral pleural, mediastinal pleura, pericardium and diaphragm | ≤34 | ≤34** |
| Flores 20085 | 1990 | 2006 | 278/663 | P/D removed tumor with the parietal and visceral pleurae and pericardium and/or diaphragm when necessary without removing the entire underlying lung | ≤278 | ≤278 |
| Schipper 200811 | 1985 | 2003 | 31/285 | … subtotal pleurectomy was defined as removal of up to 70% of the parietal pleura with debulking of as much of the mesothelioma as possible | ||
| Schipper 200811 | 1985 | 2003 | 10/285 | Total pleurectomy consisted of a complete extrapleural stripping of the parietal and mediastinal pleura and involved visceral pleura from the ipsilateral hemithorax without performing pulmonary resection. Total pleurectomy also included resection of the diaphragm and pericardium when necessary | ≤10 | ≤10 |
| Nakas 20087 | 51/102 | Non-radical: the operative objective was to remove the bulk of the tumour including both visceral and parietal pleura, to re-expand the trapped lung … The diaphragmatic and mediastinal surfaces were spared | ||||
| Nakas 20087 | 51/102 | Radical: with radical P/D the surgical objective was to achieve complete macroscopic clearance of the tumour with removal of the pericardium and diaphragm if required. Pericardium and diaphragm were reconstructed using prosthetic patches | ≤51 | ≤51 |
Where a report includes a mixture of operations and/or operated and non-operated patients the number of patients having lung sparing extirpative surgery is given as the numerator and the total number of patients in the report as the denominator
Some of these operations included planned multimodality therapies but for the purposes of this table we confine ourselves to the technical details of the extirpative surgery
The authors state ‘Decortication and pleurectomy, when possible, is the treatment of choice’ so the total versus partial presumably applies to either or both components of the surgery
The brevity of this operative detail is in marked contrast to the very full description of EPP performed in the other 40 patients in the same series
Resection of pericardium and diaphragm was sometimes not removed, or partially removed, in an unstated number of patients. ‘Partial or no removal of pericardium or diaphragm was sometimes done for a parietal pleural tumor separable from the pericardium or diaphragm.’