5/17/2023 0 Comments Barotrauma extendedIn the last years there has been a change in the preferred surgical approach for MPM, away from extrapleural pneumonectomy (EPP) and towards (extended) pleurectomy and decortication ( 9, 10). The aim of a radical surgical treatment is to achieve MCR ( 5, 8). To date, multimodality concepts including surgery are part of the most recent international guidelines ( 6, 7).ĭue to the tumor’s anatomical restraint, microscopic tumor will eventually be left behind. Although there is a decrease in incidence of MPM cases since its prohibition in most European countries since the mid/end eighties, MPM is expected to become a significant problem in third world countries in the next centuries ( 1).Īccording to the literature and our own institutional experience, a multimodality approach including neoadjuvant chemotherapy with platinum and anti-folate doublet, followed by macroscopic complete resection (MCR) offers better overall and disease-free survival than chemotherapy/surgery or no therapy alone ( 2- 5). More than 80% of all MPM cases are related to occupational exposure to asbestos with a latency period between 30 to 50 years. Malignant pleural mesothelioma (MPM) is a rare, but yet very aggressive tumor, affecting approximately 2,700 people per year in the UK and making up for less than 1% of all new cancer cases ( 1). Video 4 Reconstruction of the pericardium and the hemidiaphragm ( 29). Additionally, the prevention of possible pitfalls associated with EPD such as esophageal obstruction by the reconstructed hemidiaphragm or prolonged hospital stay due to persisting air leak are going to be discussed. We highlight the importance of repeated intraoperative biopsies and frozen section of the chest wall, the diaphragm and the pericardium to allow an accurate intraoperative staging and to adapt the surgical procedure in case of multifocal infiltration. The present article describes the surgical perspective of MPM treatment starting off with correct allocation to MCR by applying a multimodality prognostic score (MMPS), followed by a step-wise description of the EPD with resection and reconstruction of pericardium and hemidiaphragm. While MCR can be accomplished by extrapleural pneumonectomy (EPP) or extended pleurectomy and decortication (EPD), the current preferential treatment is EPD due to its lower morbidity and mortality. However, due to the morbidity associated with radical surgery and the limited life expectancy, a deliberate allocation to MCR is crucial. Up to date, the best outcome in primary treatment is achieved by a multimodality approach that includes chemotherapy, followed by macroscopic complete resection (MCR). Since tumor biology is both aggressive and highly heterogeneous at histopathological and molecular level, prediction of prognosis and treatment effect remains challenging. Policy of Dealing with Allegations of Research MisconductĪbstract: Malignant pleural mesothelioma (MPM) is a rare tumor of the visceral and parietal pleura that is most commonly associated with occupational exposure to asbestos.Policy of Screening for Plagiarism Process.They will be safe inside a Toolbelt or a Storage Container.Ĭompound N, Volatile Compound N and IC-4 Block, Nitroglycerin, Flash Powder can be triggered by other explosions. Molotov Cocktails, Nitroglycerin, Oxygenite Shards, Liquid Oxygenite, Flash Powder, Mutated Pomegrenades and Mutated Raptor Banes are at risk of exploding from hard impacts.Īll containers prevent impacts from having an effect on explosives inside.Ĭompound N, Volatile Compound N, IC-4 Blocks, Nitroglycerin, Flash Powder, Mutated Pomegrenades, Mutated Raptor Banes, Oxygen Tanks, Oxygenite Tanks, Welding Fuel Tanks and Incendium Fuel Tanks explode after short contact with fire. Potassium, Sodium, Lithium and Salt Bulbs are triggered by water.Ĭertain Containers are waterproof and it is recommended to store water-sensitive explosives in them. Some explosives can explode under certain conditions if they are not safely stored.
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