**13. Conclusion**

superior therapeutically to extrapleural pneumonectomy because these patients were able to

EPP Bille et al 2012 25 yes yes 12,8 68 EPP Rena et al 2012 19 yes yes 20 62 EPP Nakas et al 2012 99 yes yes 14,7 68 P/D Rena et al 2012 20 yes yes 25 24 P/D Nakas et al 2012 67 yes yes 13,4 43

Friedberg et al 2012 38 yes yes 31,8

Friedberg et al 2011 14 yes yes 25

EPP Yan et al 2009 70 yes yes 20 50

The results from the application of thoracic cavity lavage with hyperthermic solution and povidone iodide after pleurectomy – decortication, are promising and with fewer complica‐ tions compared to extrapleural pneumonectomy [76]. In a small series of patients that chemo‐ therapy perfusion was performed with cisplatin (100-150 mg / m) at 42 ° C for 1 h, very good results were observed. Specifically, the mean survival rate was 18 months (in combination with

In our department, the last three years, we have tried chemotherapy perfusion with peme‐ trexed (500 mg) at 42 ° C for 30 min, after pleurectomy – decortication in seven patients. Their overall treatment included radiotherapy and systemic chemotherapy (carboplatin and

**Table 8.** All recent studies of extrapleural pneumonectomy (EPP) or pleurectomy - decortication (P/D) or/and combination with hyperthermic pleural chemoperfusion or/and intracavitary photodynamic therapy (PDT) for the

radiotherapy and chemotherapy), without serious perioperative complications [89].

Zellos et al 2009 29 20 66

MEPP Friedberg et al 2011 14 8,4

EPP Buduhan et al 2009 46 yes yes 24 EPP Hasani et al 2009 18 yes yes 20,4 EPP Krug et al 2009 54 yes yes 29,1

**Radiotherapy**

**Systematic Chemotherapy**

2012 54 yes yes 23 27,7

**Median Overall Survival (months)**

**Complications (%)**

**Patient Population**

undergo even second-line chemotherapy [78].

**Publication Year**

**Study Group**

182 Principles and Practice of Cardiothoracic Surgery

Lang Lazdunski et al

**Surgical Technique**

P/D and hyperthermic pleural lavage with povidoneiodine

> P/D PDT

> P/D PDT

EPP and hyperthermic cisplatin perfusion

surgical treatment of mesothelioma

As for any other type of cancer, the treatment options for malignant pleural mesothelioma include chemotherapy, irradiation, surgery, immunotherapy or some combination of these modalities. The choice of treatment is influenced by factors like the extensive nature of this tumor, its proximity to intrathoracic organs and the general medical condition of these patients who are usually older and often have underlying diseases. Most patients due to a lack of large prospective clinical trials are treated in a highly individualized manner. Most reported studies can at best be classified as phase I type. There are very few properly structured phase II studies and no phase III studies at all.

The limitations of chemotherapy and radiotherapy have made surgery an important part of multimodality treatment for MPM. Trimodality therapy has recently emerged as a new treatment strategy to improve prognosis. To improve resectability rate and local control, induction chemotherapy is combined with aggressive surgery and post-operative radiother‐ apy. Pemetrexed has been shown to be among the most active agents and is currently used in induction trials.

Operations for MPM can be divided into two categories – those performed for palliation and those performed with curative intent. Video-assisted thoracic surgery (VATS) with talc pleurodesis is an effective way to control pleural effusions in patients who are not candidates for further surgical resection. Thoracotomy and partial pleurectomy is necessary only in situations in which the pleural effusion has loculated and cannot be evacuated by VATS. The operations performed with curative intent are extrapleural pneumonectomy (EPP) and pleurectomy – decortication (PD). Surgical treatment can be combined with hyperthermic pleural chemoperfusion or intrapleural photodynamic therapy.

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**Chapter 8**

**Thoracic Hydatid Cyst: Clinical Presentation,**

Additional information is available at the end of the chapter

Ihsan Alloubi

**1. Introduction**

traveled in endemic areas.

10% to 40% in different reported series [3].

**2. Epidemiology**

http://dx.doi.org/10.5772/53533

**Radiological Features and Surgical Treatment**

Hydatid disease is caused by an infection with the cestode Echinococcus granulosus, It has been known since the time of Galen and Hippocrates, and was described by Thebesius in the 17th century [1, 2]. Rudolphy (1808) first used the term hydatid cyst to describe echino‐ coccosis in humans [1]. It's frequently encountered in sheep- and cattle-raising regions of the world and has been observed most often in Australia, New Zealand, South Africa, South America, and Mediterranean countries. Adult worms mature in the intestine of dog (defini‐ tive host) and the eggs are released in the stool. Animals like sheep get this disease by via ingestion of contaminated vegetables. When local people living in contaminated areas (acci‐ dental host) accidentally ingest eggs after contamination of the hands by handling dogs, on‐ cospheres hatch in the duodenum, penetrate the intestines and are carried via the bloodstream to various organs. (Fig1). About 70 per cent of hydatids lodge in the liver and develop there. Those that pass the liver are likely to travel *via* the right side of the heart to the lungs, which are second to the liver in frequency of involvement. Finally, a few embryos pass through the lungs and lodge in the systemic distribution, as in brain, bones, or kidneys. The presence of pulmonary hydatid disease should be considered in patients that present with a well-defined, spherical density of the lung, particularly in those who have lived or

Annual incidence which is as high as 13-27 cases per 1, 00,000 population in certain coun‐ tries of central Asia 2. The prevalence have been of pulmonary involvement is reported to be

and reproduction in any medium, provided the original work is properly cited.

© 2013 Alloubi; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

distribution, and reproduction in any medium, provided the original work is properly cited.
