How should we treat malignant pleural mesothelioma (MPM)?
MPM is an occupational disease with increasing incidence. From 1986 to 1998 we operated 59 patients for MPM: in 11 cases only biopsy or exploration, 23 (stage T1a and T1b) Pleurectomy/Decortication, 22 (stage T2/3) extended pleuropneumonectomy (PPE) with resection of pericardium and diaphragm. In 3 cases we did additionally a chestwall resection. One patient in the PPE-group died postoperatively. Median survival time in the diagnosis/exploration group is 6 months. In the pleurectomy group (earlier stages) 14 months, in the PPE-group 16 months. One patient in the PPE-group survived 68 months, in the pleurectomy group the longest survival was 39 months. Up today 20 patients in the PPE-group died, 12 without any evidence local recurrency. Despite the fact that patients in the pleurectomy group are operated in earlier tumor stages they do not have a longer median survival time. In more than 50 percent only local disease control can be achieved by ePPE. Therefore in my opinion the first operative step must be followed by a second therapeutic step as immune- or gene therapy.
Lampl
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L
1. Surg. Clinic, Medical Center Augsburg, Germany.
Jakob
R
R
D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000601:surgery*; D010994:Pleura / Q000601:surgery; D010997:Pleural Neoplasms / Q000601:surgery*; D011013:Pneumonectomy