Update in the Treatment of Pleural Tumors: Robotic Surgery Combined with Hyperthermic Intrathoracic Chemotherapy
by
, , ,
Gaetano Romano
1,*
,
Carmelina Cristina Zirafa
1,
Ilaria Ceccarelli
1,
Gianmarco Elia
2,
Federico Davini
1 and
Franca Melfi
1 1
Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, 56124 Pisa, Italy
2
Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56124 Pisa, Italy
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(9), 1691; https://doi.org/10.3390/cancers16091691
Submission received: 3 January 2024
/
Revised: 23 April 2024
/
Accepted: 25 April 2024
/
Published: 26 April 2024
(This article belongs to the Section Cancer Biomarkers)
Simple Summary
The role of surgery in the combined treatment with hyperthermic intrathoracic chemotherapy of thymoma recurrences and pleural mesothelioma has assumed a controversial role in the context of the multimodal treatment of these diseases, especially when minimally invasive techniques are considered. The authors aim to propose future directions in the approach to these pathologies by placing robotic surgery at the center of reflection, starting, however, from a review of the literature available to date.
Abstract
(1) Background. Intracavitary hyperthermic chemotherapy (HITHOC) remains part of the complex mosaic that is the multimodal approach for advanced stage thymoma and pleural malignancies. However, robotic pleurectomy/removal of pleural lesions in combination with intrathoracic chemotherapy is not currently being investigated. The aim of this study is to evaluate the safety of robotic pleurectomy/removal of relapses and HITHOC in patients with pleural recurrence of thymoma or MPM. (2) Methods: The data of nine consecutive patients affected by thymoma relapses or MPM who underwent robotic surgery in combination with HITHOC from February 2017 to November 2022 were collected and analyzed. Surgery performed prior to intrathoracic infusion of high-temperature chemotherapy consisted of removal of recurrences (three patients) or pleurectomy (six patients). All surgeries were performed with a four-port, fully robotic technique. (3) Results: No intraoperative complications occurred. No renal complications related to infusion were recorded. One patient, who underwent pleurectomy for MPM, had a grade II Clavien–Dindo postoperative complication. Oncological follow-up showed results in line with the literature. (4) Conclusions: With the limitation of the small number of patients, robotic surgery in combination with HITHOC seems to be safe in patients with pleural relapses of thymoma and early-stage MPM.
Keywords:
pleural recurrences; HITHOC; mesothelioma; thymoma; robotic surgery; thoracic neo-plasms
