[Possibilities of diagnosis and treatment of malignant pleural mesothelioma].
Objective of our work was to evaluate: incidence, ethiology, diagnostic and treatment methods of malignant pleural mesothelioma.


METHODS
During period 1992-2001 125 cases of pleural mesothelioma were diagnosed in Lithuania. Conventional X-rays and ultrasound were used in 125 cases (100%), chest CT scans in 57 (45.6%), and chest X-rays and CT scans in 38 (30.4%) cases. In 5 cases (4.0%) we performed chest CT scans and MRI. Various surgical diagnostic methods were used: videothoracoscopy in 35 (28.0%) cases, pleural biopsies 72 (57.6%) cases, diagnostic "mini" thoracotomies - 18 (14.4%) cases. Malignant pleural mesothelioma in all cases was proved morphologically. These operations were performed: pleuropulmonectomies - 62 (60.1%), extended pleuropulmonectomies with resections of pericardium and subtotal diaphragm - 10 (9.7%), parietal pleurectomies without resection of lung and pericardium - 17 (16.5%), partial pleurectomies with resection of pericardium - 4 (3.8%), debulking of tumor (partial resections) - 10 (9.7%). Totally 103 patients were operated (82.4%). Twenty two patients were treated conservatively when diagnosis was confirmed. There were such main postoperative complications: fistulas of bronchial stump - 6 cases (5.8%), chylothorax - 5 cases (4.8%), injury of sympatic ganglion - 2 cases (1.9%), and hemothorax - 10 cases (9.7%); 3 patients (2.91%) died after operation.


RESULTS
Mean survival time after combined treatment was 12+/-2 months. After conservative treatment alone - 6.0+/-2 months. In combined treatment group 22 patients (17.6%) had recurrence of disease during 3 years. In conservative treatment group no one survived 3 years.


CONCLUSIONS
Combined surgical treatment of malignant pleural mesothelioma is still the most effective. Most of diagnosed cases were found in delayed stage. Mean survival time after combined treatment is 12.0+/-2 months, after conservative - 6.0+/-2 months, and recurrence of the disease during 3 years - 17.6% and 100% respectively.
Cicenas
Saulius
S
Institute of Oncology, Vilnius University, Santariskiu 1, 2021 Vilnius, Lithuania. cicenas@loc.lt
Zaremba
Sigitas
S
Jakubauskiene
Renata
R
D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010496:Pericardium / Q000601:surgery; D010994:Pleura / Q000473:pathology / Q000601:surgery; D010997:Pleural Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011013:Pneumonectomy; D013902:Radiography, Thoracic; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography