The effect of extent of local resection on patterns of disease progression in malignant pleural mesothelioma.
BACKGROUND
We sought to determine whether or not there are differences in disease progression after radical or nonradical (debulking) surgical procedures for malignant pleural mesothelioma.


METHODS
Over a 49-month period, 132 patients with malignant pleural mesothelioma underwent surgery. Fifty-three underwent extrapleural pneumonectomy and 79 underwent nonradical procedures. Time to evidence of clinical disease progression was recorded, as was the site(s) of that disease.


RESULTS
One-hundred nineteen patients were evaluable, of which 59% (22 radical; 48 nonradical) had disease progression. Overall 30-day mortality was 8.5% (7.5% radical; 9% nonradical). The median time to overall disease progression was considerably longer after extrapleural pneumonectomy than debulking surgery (319 days vs 197 days, p = 0.019), as was the time to local disease progression (631 days vs 218 days, p = 0.0018). There was no preponderance of earlier stage disease in the radical surgery group. There was a trend toward prolonged survival in those undergoing radical surgery, but no significant difference between the groups (497 days vs 324 days, p = 0.079). In those who had extrapleural pneumonectomy, time-to-disease progression significantly decreased with N2 disease compared with N0/1 involvement (197 days vs 358 days, p = 0.02).


CONCLUSIONS
Extrapleural pneumonectomy may be preferable to debulking surgery in malignant pleural mesothelioma to delay disease progression and give greater control of local disease. Involvement of N2 nodes is associated with accelerated disease progression and is therefore a contraindication to extrapleural pneumonectomy.
Stewart
Duncan J
DJ
Department of Thoracic Surgery, Glenfield Hospital, Leicester, United Kingdom.
Martin-Ucar
Antonio
A
Pilling
John E
JE
Edwards
John G
JG
O'Byrne
Kenneth J
KJ
Waller
David A
DA
D000008:Abdominal Neoplasms / Q000556:secondary; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D000075202:Contraindications; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003964:Diaphragm / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008654:Mesothelioma / Q000145:classification / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D010496:Pericardium / Q000601:surgery; D010997:Pleural Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods / Q000706:statistics & numerical data*; D011379:Prognosis; D019736:Prostheses and Implants; D018714:Radiotherapy, Adjuvant; D013526:Surgical Mesh; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000706:statistics & numerical data; D016896:Treatment Outcome; D000093542:Gemcitabine
D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine