Research

Yan TD, Tin M, Boyer M, McLean J, G Bannon P, McCaughan BC

J Thorac Dis 2009 Dec;1(1):23-8

PMID: 22262998

Abstract

BACKGROUND: Extrapleural pneumonectomy (EPP) has been used as a treatment option for selected patients with malignant pleural mesothelioma (MPM). The primary end-point of this study was disease-free survival (DFS). Prognostic indicators for local and overall DFS were statistically analyzed.

METHODS: Between October 1994 to April 2008, 59 patients who had complete macroscopic cytoreduction after EPP formed the basis of this report. In recent years, selected patients received adjuvant radiotherapy and pemetrexed combined with cisplatin or carboplatin. The clinicopathologic data of all patients were prospectively collected in a computerized database. Statistical analysis was performed by using Kaplan-Meier method and compared using the log-rank test. Cox-regression model was used for multivariate analysis.

RESULTS: The mean age at the time of EPP was 59 (S.D. = 8) years. Nineteen patients (32%) experienced perioperative complications. The median survival was 21 months (range 2 to 104). The local disease recurrence rate was 51%. The median local DFS was 22 months (0 to 73). The overall disease recurrence rate was 64%. The median overall DFS was 18 months (range 0 to 73). In multivariate analysis, epithelial subtype (p = 0.026) and adjuvant radiotherapy (p = 0.023) were independently associated with an improved local DFS. Adjuvant radiotherapy (p = 0.011) was also independently associated with an improved overall DFS.

CONCLUSIONS: This study demonstrated that that local disease failure was still a considerable clinical problem following complete EPP. The data also showed that patients with epithelial histology and receiving adjuvant radiotherapy were associated with an improved disease control.

Poh CL, Yan TD

J Thorac Dis 2010 Mar;2(1):6-8

PMID: 22263009

Abstract

Ramponi F, Leslie A, Stephen MS, White GH, Jeremy R, Wilson MK

Ann. Thorac. Surg. 2012 Jan;93(1):358-9; author reply 359-60

PMID: 22186475

Abstract

Edelman JJ, Yan TD, Vallely MP

J. Thorac. Cardiovasc. Surg. 2012 Jan;143(1):251-2; author reply 252

PMID: 22172760

Abstract

Edelman JJ, Vallely MP

Heart Lung Circ 2011 Dec;20(12):776

PMID: 21831709

Abstract

Rahnavardi M, Yan TD, Cao C, Vallely MP, Bannon PG, Wilson MK

Ann Thorac Cardiovasc Surg 2011;17(5):435-45

PMID: 21881372

Abstract

PURPOSE: Pulmonary thromboendarterectomy (PTE) is a treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH). The present systematic review was performed to assess the safety and efficacy of PTE for CTEPH.

METHODS: A systematic review was performed, and six electronic databases were searched for published studies from January 1999 to February 2010. All articles that presented morbidity and mortality data, survival data or preoperative and postoperative pulmonary hemodynamic indices were included. The primary outcome measures extracted were early morbidity and mortality, pulmonary hemodynamic and functional outcome indices prior to and after the operation, and survival data.

RESULTS: Of the 654 publications retrieved, 19 relevant papers (total number of 2729 patients) representing the most recent and complete data set from each institute, were included for appraisal and data extraction. No randomized controlled trials or matched comparative studies were identified. Thirty-day mortality ranged from 1.3% to 24% (median 8%). Residual pulmonary hypertension was reported in 11%-35% of patients after PTE. Pulmonary artery pressure and pulmonary vascular resistance significantly decreased after PTE in all studies. Before PTE, 60%-100% of patients were in NYHA functional class III or IV. This percentage decreased to 0%-21% after PTE. Five-year survival ranged from 74% to 89%.

CONCLUSIONS: The current literature suggests that PTE for patients with CTEPH is associated with acceptable perioperative morbidity and mortality rates and improved hemodynamic indices and survival when viewed against the prognosis associated with historical controls using medical therapy.

Davies RA, Black D, Jeremy RW, Bannon PG, Bayfield MS, Hendel PN, Hughes CF, Wilson MK, Vallely MP

Heart Lung Circ 2011 Nov;20(11):704-11

PMID: 21872527

Abstract

BACKGROUND: Aortic arch replacement is a complicated and high risk procedure. There have been many advances over recent years. We review the changes in our unit’s techniques and outcomes over the past 22 years.

METHODS: Data were collated from databases and medical records for all patients who underwent aortic arch replacement surgery from January 1989 to December 2010. The patients were divided into two groups – Group A (1989-2005) and Group B (2006-2010). Data were analysed to compare early and late series patients’ outcomes. Logistic regression was used to identify variables that predicted mortality.

RESULTS: Seventy-five eligible patients (56 males; mean age: 57.5 years; Group A: 40, Group B 35) were identified. There were great changes in the technique and the methods of cerebral protection. The overall mortality rate was 30.7% – Group A: 50% and Group B: 8.6% (p<0.001). Overall permanent neurological dysfunction was 23.7% – Group A: 40% and Group B: 11.8% (p=0.012). Cardiovascular disease and circulatory arrest time were significant predictors of mortality.

CONCLUSIONS: Increased experience and volume and advances in techniques over 22 years have resulted in major improvements in outcomes for patients having aortic arch replacement, allowing the procedure to be performed with greatly improved outcomes.

Cooper EA, Edelman JJ, Wilson MK, Bannon PG, Vallely MP

Heart Lung Circ 2011 Nov;20(11):694-703

PMID: 21862405

Abstract

Elderly and high-risk patients are increasingly being considered for myocardial revascularisation. Most trials comparing the various options for revascularisation exclude elderly and ‘high-risk’ patients. We have reviewed the options for myocardial revascularisation for elderly patients, and for patients with a number of common ‘high-risk’ co-morbidities–diabetes mellitus, renal insufficiency, poor left ventricular ejection fraction, peripheral vascular disease, left main coronary artery disease and chronic obstructive pulmonary disease–with a focus on coronary artery bypass grafting without the use of cardiopulmonary bypass and aortic manipulation.

Ramponi F, Vallely MP

Heart Lung Circ 2011 Sep;20(9):606-7

PMID: 22132418

Abstract

Cao C, Yan TD, Bannon PG, McCaughan BC

Ann. Surg. Oncol. 2011 Oct;18(10):2973-9

PMID: 21512863

Abstract

BACKGROUND: Extrapleural pneumonectomy (EPP) has been shown to improve long-term survival outcomes in selected patients with malignant pleural mesothelioma (MPM). The present study aimed to evaluate potential prognostic factors on overall survival for patients who underwent EPP for MPM and to examine the patient selection process in major referral centers that perform EPP.

METHODS: A systematic review of the current literature was performed using 5 electronic databases. Relevant studies with prognostic data on overall survival for patients with MPM treated by EPP were included for review. Two reviewers independently assessed each included study.

RESULTS: A total of 17 studies from 13 institutions containing the most updated and complete data on prognostic factors for patients with MPM who underwent EPP were included for review. A number of quantitative, clinical, and treatment-related factors were identified to have significant impact on overall survival.

CONCLUSIONS: Patients with nonepithelial MPM and nodal involvement have consistently demonstrated to have a worse prognosis after EPP. Their eligibility as candidates for EPP should be questioned. The preoperative patient selection process currently differs greatly between institutions and should focus on identifying patients with nonepithelial histologic subtypes and nodal involvement to exclude them as EPP surgical candidates in the future.