Safety and Feasibility of Intrathoracic Chemohyperthermia after Pleural Cytoreduction: A Single-Institution Experience with 50 Patients and Literature Review

Tabutin M, Glehen O, Maury JM, Durand E, Sayag-Beaujard AC, Souquet PJ and Tronc F

Department of Thoracic Surgery, Hospital Louis Pradel, France
Department of Oncologic and General Surgery, University Lyon 1, France
Department of Clinical Research Unit, University Lyon 1, France
Department of Anesthesiology, University Lyon 1, France
Department of Pneumology, Hospices Civils de Lyon, France

^*Correspondance to: Fran�ois Tronc 

 PDF  Full Text DOI: 10.25107/2474-1647.2114

Abstract

Background: Pleural malignancy treatment produces disappointing results, even with current multimodal therapeutics. Cytoreductive surgery combined with Intrathoracic Chemohyperthermia (ITCH) is an under-evaluated therapeutic option. We aim to investigate the feasibility and the postoperative results of this technique.Methods: We retrospectively reviewed the postoperative courses of 50 patients who underwent ITCH between 1990 and 2014. Data on histologic type of pleural tumor, type of surgery, ITCH performed, and postoperative course were analyzed.Results: The operated patients included 19 women and 30 men, with an average age of 55.3 years (range, 21-73 years). Twenty-seven patients had mesothelioma, 9 pleural metastasis of thymoma, and 14 pleural metastasis of other histological type. All patients underwent partial or subtotal pleurectomy, without major anatomic resection. ITCH was performed for over 90 min; at an inflow temperature of <45°C; with mitomycin C, cisplatin, or both. One post-operative death occurred, due to acute respiratory distress syndrome. Post-operative complications included hemorrhage (n=2), pleural abscess (n=1), persistent air leaks (n=2), wound sepsis (n=4), aplasia (n=1), and renal insufficiency (n=1). Average drainage duration was 6.3 days (range, 3-14 days) and average length of hospital length stay was 10 days (range, 6-18 days).Conclusion: ITCH combined with cytoreductive surgery appears to be a surgical procedure with acceptable mortality and morbidity rates. Its efficiency according to tumor type should be further evaluated, specifically with regard to types and doses of chemotherapeutic agents.

Keywords

Pleural disease; Thoracic surgery; Cytoreduction; ChemoHyperthermia; Morbidity

Cite the article

Tabutin M, Glehen O, Maury JM, Durand E, Sayag-Beaujard AC, Souquet PJ, et al. Safety and Feasibility of Intrathoracic Chemohyperthermia after Pleural Cytoreduction: A Single- Institution Experience with 50 Patients and Literature Review. Clin Surg. 2018; 3: 2114.