Anaesthetic and perioperative considerations for extrapleural pneumonectomy and extended pleurectomy/decortication: a scoping review protocol

Our plain-English summary of Anaesthetic and perioperative considerations for extrapleural pneumonectomy and extended pleurectomy/decortication: a scoping review protocol, by S.W.S. Yip, L. Weinberg, J. Gooi, et al (BMJ Open, 2024).

The study

• Authors: S.W.S. Yip, L. Weinberg, J. Gooi, S. Sivenayagam, T.G. Coulson, S.A. Barnett, S.R. Knight, J. Ludski, D.K. Lee
• Journal: BMJ Open
• Published: 2024;14(5):e078125
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Extrapleural pneumonectomy (EPP) and extended pleurectomy/decortication (ePD) are surgical cytoreductive techniques aimed at achieving macroscopic resection in malignant pleural tumours such as pleural mesothelioma, non-mesothelioma pleural malignancies such as thymoma and sarcoma, and rarely for pleural tuberculosis, in a more limited fashion. Despite extensive studies on both surgical techniques and consequences, a significant knowledge gap remains regarding how best to approach the perioperative anaesthesia challenges for EPP and ePD.It is unknown if the risk stratification processes for such surgeries are standardised or what types of functional and dynamic cardiac and pulmonary tests are employed preoperatively to assist in the perioperative risk stratification. Further, it is unknown whether the types of anaesthesia and analgesia techniques employed, and the types of haemodynamic monitoring tools used, impact on outcomes. It is also unknown whether individualised haemodynamic protocols are used to guide the rational use of fluids, vasoactive drugs and inotropes.Finally, there is a dearth of evidence regarding how best to monitor these patients postoperatively or what the most effective enhanced recovery protocols are to best mitigate postoperative complications and accelerate hospital discharge. To increase our knowledge of the perioperative and anaesthetic treatment for patients undergoing EPP/ePD, this scoping review attempts to synthesise the literature and identify these knowledge gaps.

Methods And Analysis: This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review Protocols methodology. Electronic databases, OVID Medline, EMBASE and the Cochrane Library, will be systematically searched for relevant literature corresponding to EPP or ePD and perioperative or anaesthetic management. Data will be analysed and summarised descriptively and organised according to the three perioperative stages: preoperative, intraoperative and postoperative factors in clinical care.

Ethics And Dissemination: Ethics approval was not required. The findings will be disseminated through professional networks, conference presentations and publications in scientific journals.

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This article is a protocol for a planned scoping review and reported no results. The review was to gather published research on anaesthesia and care around surgery for patients having extrapleural pneumonectomy (EPP) or extended pleurectomy/decortication (ePD). These operations are used mainly for pleural mesothelioma, also for other pleural cancers such as thymoma and sarcoma, and rarely for pleural tuberculosis. The authors planned to search Medline, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials for studies from 1 January 1949 to 6 March 2024, with no age limit. Two reviewers would screen studies and extract data independently, with a third resolving disagreements. Findings would be summarised descriptively by stage of care (before, during and after surgery). Planned topics included risk assessment, anaesthesia and pain relief, complications, hospital stay, death rates and quality of life. Studies without an English abstract would be excluded, but non-English full texts with an eligible English abstract would be translated. The authors noted that this English restriction could bias the review towards English-speaking countries, and that the review may miss studies published outside journals. The article did not study asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Protocol for a scoping review of published literature. It reports planned methods only, with no results.
• Who was studied: Planned: published studies of patients of any age undergoing EPP or ePD, from 1 January 1949 to 6 March 2024, found in Medline, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials. The operations are used primarily for pleural mesothelioma.
• Exposure: Not an asbestos exposure study. The topic is perioperative and anaesthetic management of the surgeries extrapleural pneumonectomy and extended pleurectomy/decortication. No fiber types or occupational exposures are examined.
• The authors' conclusion: As a protocol, the article gives no findings. The authors stated that the planned review could help identify current evidence and knowledge gaps for anaesthetists and perioperative clinicians caring for patients undergoing EPP/ePD.
• Limitations the authors state:
  • The review is restricted to English. Studies without an English abstract will be excluded, though non-English full manuscripts with an eligible English abstract will be translated and included. The authors said this restriction may bias the review towards English-speaking countries.
  • The review may miss studies published outside journals, such as book chapters and other grey literature.

Topics

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D), Cytoreductive Surgery, Pleural Mesothelioma, Mesothelioma, Sarcoma, Systematic Review, Meta-Analysis.

Related studies

• Extrapleural Pneumonectomy Versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma — N. Zhou, D.C. Rice, et al. (2022)
• Short-term outcomes of pleurectomy decortication and extrapleural pneumonectomy in mesothelioma — M. van Gerwen, A. Wolf, et al. (2018)
• Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma — E. Taioli, A.S. Wolf, et al. (2015)
• Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma — S. Hasegawa (2014)
• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)
• Extrapleural Pneumonectomy and Pleurectomy Decortication: Can We Really Compare Their Survival? — P. Bertoglio, S. Korasidis (2015)

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