Outcome after extrapleural pneumonectomy for malignant pleural mesothelioma
Tuesday, April 15th, 2008.
European Journal of Cardio-Thoracic Surgery. 2008 Apr 11 [Epub ahead of print] [Link]
Aigner C, Hoda MA, Lang G, Taghavi S, Marta G, Klepetko W.
Department of Cardio-Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria.
Abstract
Background: Malignant pleural mesothelioma is a mainly asbestos-related neoplasm that occurs with increasing frequency and is associated with a poor prognosis. Extrapleural pneumonectomy which was initially performed as a stand-alone treatment in patients with resectable disease is now currently almost uniformly applied as part of a multi-modal approach. Its value and advantage over other therapeutic strategies remain points of discussion. We therefore analysed our experience with extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma.
Methods: We retrospectively reviewed our institutional experience with all consecutive patients undergoing extrapleural pneumonectomy for malignant pleural mesothelioma from 1994 to 2005. Patients were analysed with regard to hospital mortality and morbidity and long-term outcome.
Results: Forty-nine patients (10 female/39 male, mean age 58 + 12 years) underwent extrapleural pneumonectomy during the observation period. Median ICU stay was 1 day, median postoperative length of hospital stay was 13 days. After a mean follow-up of 2573 days, median survival was 376 days (mean 672 + 121 days, range 9–3384). One-year survival was 53%, 3-year survival 27% and 5-year survival 19%.
Conclusion: Extrapleural pneumonectomy as part of a multi-modality treatment regimen is a good treatment option for selected patients with malignant pleural mesothelioma. The long-term results of this limited series compare favourably to non-surgical treatment regimens. Larger randomised prospective multi-centre trials are warranted to establish clear guidelines.
Keywords: Malignant pleural mesothelioma; Extrapleural pneumonectomy; Pleuropneumonectomy; Multi-modal treatment; MPM; EPP
Glossary
- regimen
- (rej-uh-men) a strict, regulated plan (such as diet, exercise, or other activity) designed to reach certain goals. In cancer treatment, a plan to treat cancer.
- prognosis
- (prog-no-sis) a prediction of the course of disease; the outlook for the cure of the patient. For example, women with breast cancer that was detected early and who received prompt treatment have a good prognosis.
- neoplasm
- (nee-o-plas-um) an abnormal growth (tumor) that starts from a single altered cell; a neoplasm may be benign or malignant. Cancer is a malignant neoplasm.
- morbidity
- a measure of the new cases of a disease in a population; the number of people who have a disease.
- mortality
- a measure of the rate of death from a disease within a given population.
- mesothelioma
- a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.
- extrapleural pneumonectomy
- (EPP) surgery to remove the pleura, diaphragm, pericardium, and entire lung involved with the tumor. You can view a web cast from Brigham and Women's Hospital in Boston of this procedure being done by Dr. David Sugarbaker: see the extrapleural pneumonectomy (EPP) web cast here.
