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Extrapleural pneumonectomy for sarcoma: outcomes of adult patients at a specialized center and literature review.
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  • Betty Zhang,
  • Ashley Wilson-Smith,
  • Elizabeth Connolly,
  • Madeleine Strach,
  • Nathan Ussher,
  • Tristan Yan,
  • Vivek Bhadri
Betty Zhang
Chris O'Brien Lifehouse

Corresponding Author:betty.zhang@lh.org.au

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Ashley Wilson-Smith
The University of Sydney
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Elizabeth Connolly
Chris O'Brien Lifehouse
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Madeleine Strach
Chris O'Brien Lifehouse
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Nathan Ussher
The University of Sydney
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Tristan Yan
The University of Sydney
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Vivek Bhadri
Chris O'Brien Lifehouse
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Abstract

Background: Extrapleural pneumonectomy (EPP) is a complex surgical procedure involving en-bloc resection of the parietal and visceral pleura, lung, pericardium, and ipsilateral diaphragm. Small case series of pleural-based sarcoma of predominantly paediatric patients suggest EPP may be a life-prolonging surgical option. We aimed to describe the characteristics and outcomes of adults who underwent EPP at a specialized sarcoma center. Methods: Clinicopathologic variables, surgical details and follow-up information were extracted for eight patients undergoing EPP for pleural-based sarcoma between 2017-2020. Primary outcomes were event-free survival (EFS) and overall survival (OS) from the date of EPP. Secondary outcomes were disease-free interval (DFI) prior to EPP, and early and late postoperative complications. Results: At median follow-up of 22.5 months, median EFS was 6.0 months and OS was 20.7 months. Six patients had disease recurrence; five patients died of progressive disease. Two patients had not recurred: one died of a radiation-related esophageal rupture, and one was alive with no evidence of disease at 37.0 months. Characteristics of those with the longest EFS included low-grade histology and achieving a metabolic response to preoperative chemotherapy. Early postoperative complications included one ventilator-associated pneumonia with new-onset atrial fibrillation and two cases of hydropneumothorax. Late surgical complications included a case of infective endocarditis and septic shock. Conclusions: In adult sarcoma patients, EPP is rarely curative but appears to be a feasible salvage procedure when performed at specialized centers. Patient selection is critical, with a strong consideration for multimodal treatment to optimize oncological outcomes.
13 Aug 2023Submitted to Cancer Reports
14 Aug 2023Submission Checks Completed
14 Aug 2023Assigned to Editor
14 Aug 2023Review(s) Completed, Editorial Evaluation Pending
22 Aug 2023Reviewer(s) Assigned
16 Nov 2023Editorial Decision: Revise Major
21 Mar 20242nd Revision Received
22 Mar 2024Submission Checks Completed
22 Mar 2024Assigned to Editor
22 Mar 2024Review(s) Completed, Editorial Evaluation Pending
31 Mar 2024Editorial Decision: Accept