TITLE

Open lung-sparing surgery for malignant pleural mesothelioma: the benefits of a radical approach within multimodality therapy

AUTHOR(S)
Nakas, Apostolos; Trousse, Delphine Sophie; Martin-Ucar, Antonio E.; Waller, David A.
PUB. DATE
October 2008
SOURCE
European Journal of Cardio-Thoracic Surgery;Oct2008, Vol. 34 Issue 4, p886
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Abstract: Objective: To identify the optimal debulking procedure in patients with malignant pleural mesothelioma who are not suitable for extrapleural pneumonectomy (EPP). Methods: We reviewed 102 consecutive patients (93 male; 9 female, mean age 63 years) who were not suitable for EPP because of either advanced tumour stage or suboptimal fitness. Patients underwent either a non-radical tumour decortication to obtain lung expansion (group NR) or latterly a radical pleurectomy/decortication to obtain macroscopic tumour clearance (group R). We analysed the comparative perioperative courses and long-term survival. Results: The two groups were similar for age and gender distribution but epithelioid type was more predominant in group R: 78% compared to 55% epithelioid in group NR. Thirty-day mortality was similar (5.9% in group R and 9.8% in the group NR, p =0.36) but 90-day mortality was significantly higher in the group NR (29.4% vs 9.8% in group R, p =0.012). More patients in group R received adjuvant chemotherapy (65% vs 28%, p =0.000) and radiotherapy (65% vs 26%, p =0.000). Median survival for all cell types was significantly higher in group R (15.3 months vs 7.1 months, p <0.000). Group R survival rates at 1, 2, 3 and 4 years were 53, 41, 25 and 13%, respectively while for group NR they were 32, 9.6, 2 and 0%, respectively. For epithelioid cell type there was still a significant median survival advantage in group R (25.4 months vs 10.2 months, p <0.000), but there was no difference for sarcomatoid (9.3 months vs 3.2 months, p =0.16) or biphasic cell types (9.4 months vs 7 months, p =0.38). Conclusion: If a patient with epithelioid MPM is fit enough to tolerate a thoracotomy then macroscopic clearance of the tumour is the preferred option as part of a multimodality regime including chemotherapy.
ACCESSION #
34649577

 

Related Articles

  • Belmont Hyperthermia Pump in the conduct of intra-operative heated chemotherapy. Riley, W. // Perfusion;Mar2009, Vol. 24 Issue 2, p115 

    Intra-operative heated chemotherapy (IOHC) has been performed in the Thoracic surgical department of Brigham and Women's Hospital (BWH, Boston, MA, USA) for over a decade. A "home-grown" system was developed for this purpose with limited improvements made to it through the years. This technology...

  • Multicenter trial of neo-adjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma. W Weder; RA Stahel; J Bernhard; S Bodis; P Vogt; P Ballabeni; D Lardinois; D Betticher; R Schmid; R Stupp; HB Ris; M Jermann; W Mingrone; AD Roth; A Spiliopoulos; On behalf of the Swiss Group for Clinical Cancer Research // Annals of Oncology;Jul2007, Vol. 18 Issue 7, p1196 

    Background: The aim of this multicenter trial was to prospectively evaluate neo-adjuvant chemotherapy followed by extrapleural pneumonectomy (EPP) and radiotherapy, including quality of life as outcome. Patients and methods: Eligible patients had malignant pleural mesothelioma of all...

  • Posaconazole-Induced Topiramate Toxicity. Marriott, Deborah; Levy, Russell; Doyle, Tom; Ray, John // Annals of Internal Medicine;7/21/2009, Vol. 151 Issue 2, p143 

    The article presents the case study of a 48-year-old white man who underwent partial pneumonectomy for invasive aspergilloma after radiation therapy. It was hypothesized that posaconazole inhibition of CYP450 3A4 caused the patient's elevated topiramate levels. It is also reported that in order...

  • Induction chemotherapy does not increase the operative risk of pneumonectomy! Mansour, Ziad; Kochetkova, Evgenia A.; Ducrocq, Xavier; Vasilescu, Mircea-Dan; Maxant, Guillaume; Buggenhout, Alexis; Wihlm, Jean-Marie; Massard, Gilbert // European Journal of Cardio-Thoracic Surgery;Feb2007, Vol. 31 Issue 2, p181 

    Abstract: Background: There is an ongoing debate whether induction therapy increases post-operative mortality and morbidity, especially when performing pneumonectomy. We therefore reviewed a consecutive series of patients having undergone pneumonectomy in a single center. Methods: The charts of...

  • Indications and results of completion pneumonectomy. Jungraithmayr, Wolfgang; Hasse, Joachim; Olschewski, Manfred; Stoelben, Erich // European Journal of Cardio-Thoracic Surgery;Jul2004, Vol. 26 Issue 1, p189 

    Objectives: Completion pneumonectomy (CP) is widely known to be associated with a high morbidity and mortality. However, in certain instances, CP offers the only chance for a cure. The results of the following three groups were investigated: progressive or recurrent benign disease, recurrence of...

  • Malignes Pleuramesotheliom. Bölükbas, S.; Schirren, J. // Der Chirurg;Jun2013, Vol. 84 Issue 6, p487 

    The role of surgical resection per se and the type of surgery in the management of multimodality treated malignant pleural mesothelioma remains controversial. Patient selection for either extrapleural pneumonectomy or radical pleurectomy depends not only on the cardiopulmonary status of the...

  • Incidence and management of complications after neoadjuvant chemotherapy followed by extrapleural pneumonectomy for malignant pleural mesothelioma Opitz, Isabelle; Kestenholz, Peter; Lardinois, Didier; Müller, Michael; Rousson, Valentin; Schneiter, Didier; Stahel, Rolf; Weder, Walter // European Journal of Cardio-Thoracic Surgery;Apr2006, Vol. 29 Issue 4, p579 

    Abstract: Objective: To investigate the incidence and management of postoperative complications after neoadjuvant chemotherapy followed by extrapleural pneumonectomy for malignant pleural mesothelioma. Methods: Patients with histologically proven mesothelioma of clinical stages T1–3,...

  • Thoracic surgery and interventional procedures.  // Thorax;Dec2005 Supplement 2, Vol. 60, pii46 

    The article presents several abstracts related to thoracic surgery. They include "The Use of Predicted Post Operative Lung Function to Predict Duration of Intensive Care Unit Admission Following Pulmonary Resection for Malignancy," by A. Jha, E.M. Thomson, D.D. Melley, G. Ladas and T.W. Evans,...

  • Pleural Mesothelioma: An Institutional Experience of 66 Cases. Soomin Ahn; In Ho Choi; Joungho Han; Jhingook Kim; Myung-Ju Ahn // Korean Journal of Pathology;Apr2014, Vol. 48 Issue 2, p91 

    Background: Malignant mesothelioma of the pleura is an aggressive tumor known to be associated with asbestos. Histological diagnosis of mesothelioma is challenging and is usually aided by immunohistochemical markers. Methods: During an 18-year period (1995-2012), 66 patients with pleural...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics