A narrative review of video-assisted debulking surgery and hyperthermic intraoperative thoracic chemotherapy (HITHOC) for malignant pleural mesothelioma

Background and Objective: Malignant pleural mesothelioma (MPM) is a cancer that carries a dismal prognosis. At the present time the role of video-assisted thoracic surgery (VATS) as an approach to operate patients with MPM is becoming more common. Furthermore, an increase in the use of hyperthermic intraoperative thoracic chemotherapy (HITHOC) is visible in the medical literature. The main objective of this paper is to provide an overview of the key findings and debates of VATS and HITHOC for the treatment of MPM. Methods: A review was conducted on studies pertaining to the use of VATS to treat MPM and the HITHOC. The search was performed using PubMed/MEDLINE, Web of Science, Scopus and Google Scholar. The studies were assessed to evaluate the perioperative and long-term outcomes. Key Content and Findings: Most of the studies presented in the manuscript are very encouraging. Current literature suggests that the use of VATS is feasible and it can be proposed not only for talc pleurodesis but also to perform pleurectomy/decortication (P/D) to treat MPM. VATS also offers similar or better perioperative outcomes than open approaches. In addition, there is robust evidence based on published data suggesting that the use of HITHOC may be appropriate to prolong survival in patients with epitheliod MPM. Conclusions: VATS is an appropriate approach for MPM. Nevertheless, more level 2 evidence is necessary to convince oncologists and thoracic surgeons to use HITHOC as an "adjuvant" treatment. Future prospective multi-institutional studies (a global trial) will be needed in order to fully evaluate the value of VATS and HITHOC in treating MPM.