Extrapleural Pneumonectomy and Hyperthermic Intrathoracic Chemotherapy in Malignant Pleural Mesothelioma
Year: 2026
Type: article
Abstract: entire pleural surface.Prominent mediastinal nodes in prevascular, pretracheal, aortopulmonary (AP) window, subcarinal, and left hilar region.EPP with HITHOC was planned.Patient was advised highprotein diet, chest physiotherapy, and nebulization with salbutamol and ipratropium bromide every 6 hours.After informed written consent, central line in the right internal jugular vein and thoracic epidural catheter was secured.Preop arterial blood gas analysis (ABGA) suggested pH 7.524, pO 2 64.4 mm Hg, pCO 2 32 mm Hg, and HCO 3 25.5 mmol/L.Monitor was applied for continuous invasive blood pressure (BP), pulse pressure variation (PPV), central venous pressure (CVP), nasopharyngeal temperature, peripheral capillary oxygen saturation (SpO 2 ), end-tidal carbon dioxide (EtCO 2 ), and ECG monitoring.After securing IV line, inj.glycopyrrolate 0.2 mg, inj.ranitidine, inj.ondansetron, inj.fentanyl 100 µg, and antibiotics were given intravenously.After preoxygenation with 100% O 2 for 5 minutes, anesthesia was induced with inj.propofol 100 mg and inj.atracurium 30 mg intravenously.A 37 Fr right-sided double-lumen endotracheal tube (DLT) was placed, position confirmed with fiberoptic bronchoscopy and by auscultation.Anesthesia was maintained with oxygen, air, sevoflurane, and inj.atracurium.Patient was given right IntroductIonMalignant pleural mesothelioma (MPM) is a rare primitive type of malignancy with poor prognosis and poor survival.Symptoms include chest pain, dyspnea, persistent cough, and weight loss, often appearing in advanced stage. 1 Curative therapy for MPM requires multimodal approach, including surgical resection with chemotherapy and radiotherapy.Extrapleural pneumonectomy (EPP) is en bloc removal of the parietal and visceral pleura, lung, pericardium, and diaphragm to achieve macroscopic clearance.2 Hyperthermic intrathoracic chemotherapy (HITHOC) is combined with EPP in the operation theater right after surgery into the thoracic cavity to achieve microscopic tumor control.2,3 Increased temperature improves permeability and local cytotoxic effect with reduced systemic toxicity and improved overall survival and disease-free survival.[4][5][6] Anesthetic management in EPP with HITHOC is challenging due to prolonged surgery, one-lung ventilation (OLV), major blood loss and fluid shifts, rapid rise in temperature, direct handling of the heart, nephrotoxicity, and electrolyte imbalance.7 Though HITHOC has been successfully used in MPM, high perioperative complication and mortality rate, HITHOC is not widely used.There is a lack of guideline regarding clinical protocol, techniques of surgical aspects, indications, patient selection, choice of antitumor drug perfused and dosage, temperature, time, and type of perfusion machine.We intended to share our experience of management of this case undergone cytoreductive surgery and HITHOC. case descrIptIonA 55-year-old female, weighing 50 kg, presented with complaint of dry cough and weight loss for 6 months.She had no comorbidities and no history of smoking/alcohol.She had taken two cycles of chemotherapy with pemetrexed and cisplatin.Breath sounds were reduced on the left lower zone.Other systemic examination, including blood investigations, echocardiography, and electrocardiogram (ECG), were normal (Figs 1 and 2).Pulmonary function test showed moderate restrictive dysfunction.Computed tomography (CT) thorax showed pleural-based soft tissue mass on the left side involving the 1-
Authors: Leena P Patel, Neeta D Gosai, Dinkal A Patel
Institution: Gujarat Cancer & Research Institute
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7130819236