Radical surgery for malignant pleural mesothelioma: results and prognosis
Interactive CardioVascular and Thoracic Surgery. 2007 Nov 29 [Epub ahead of print] [Link]
Okada M, Mimura T, Ohbayashi C, Sakuma T, Soejima T, Tsubota N.
Hiroshima University, Japan.
The role of surgical treatment for malignant pleural mesothelioma (MPM) continues to be controversial. We carried out a retrospective review of the prognosis in patients who had radical surgery for MPM. Of 87 consecutive patients who performed surgical exploration for biopsy-proven MPM, 31 patients underwent extrapleural pneumonectomy (EPP) and 34 patients underwent pleurectomy/decortication (P/D). Sixty-five patients having EPP or P/D included 58 men (89%). The median age was 60 years (35-78 range) and the histologic type was epithelial in 48 patients (74%). IMIG staging classification was p-stage I disease in 8 patients (12%), p-stage II in 13 (20%), p-stage III in 40 (62%) and p-stage IV in 4 (6%). Operative mortality was 3.2% for EPP and none for P/D. The median and 3-year survivals after EPP were 13 months and 33% whereas those after P/D were 17 months and 24%, respectively. A multivariate analysis demonstrated that older age (p=0.0467), non-epithelial histology (p=0.0057) and p-stage III-IV disease (p=0.0019), but not gender, side, surgical procedure, were significant independent negative prognostic factors. Although P/D appears to be acceptable in early stages, we encourage EPP, en bloc resection without entering the pleural cavity with intent for curability, which provides oncologically complete resection of all disease.
Keywords: Malignant mesothelioma; Extrapleural pneumonectomy; Pleurectomy/decortication; Survival.