Perioperative Anaesthesiological Management of Malignant Pleural Mesothelioma Patients Undergoing Extrapleural Pneumonectomy (EPP) and Extended Pleurectomy/Decortication ((E)PD)

Abstract

Introduction: Macroscopic complete resection (MCR) within a multimodality treatment concept offers currently the best survival for malignant pleural mesothelioma patients. The current standardised therapy is within a multimodality approach including (neo-)adjuvant chemotherapy followed by macroscopic complete resection (MCR). However, MCR in form of extrapleural pneumonectomy (EPP) or extended pleurectomy/decortication ((E)PD) is correlated with significant morbidity and mortality if not performed in high volume centres as described previously according to the literature. In addition, there exist no standardised anaesthesiological protocol for this surgical approach according to the literature.

Methods: At our institution, diagnosed mesothelioma patients up to an International Mesothelioma Interest Group (IMIG) stage III receive induction chemotherapy followed by either EPP or (E)PD and in certain cases additional adjuvant therapy. In the period 1999-end 2019, 362 patients were intended to be treated and 303 underwent induction chemotherapy followed by MCR. MCR can be achieved either by EPP or (E)PD. Both procedures request a good teamwork between the surgeon and the anaesthesiologist.

Conclusion: Although, there has been a shift lately from EPP towards lung sparing procedure (E)PD, both surgical approaches are still performed to date and is a challenging procedure for both, the surgeon as well as the anaesthesiologist. Herewith, we present our institutional perioperative standard operating procedures for the surgical and anaesthesiological management of EPP or (E)PD according to international terms of reference.