title: Impact of lymph node metastasis on outcome after extrapleural pneumonectomy for malignant pleural mesothelioma.
abstract: OBJECTIVE
  Extrapleural pneumonectomy is a therapeutic option for selected patients with malignant pleural mesothelioma. The impact of lymph node metastasis on the site of recurrence and the role of mediastinoscopy in the selection of patients for extrapleural pneumonectomy, however, remain unclear.
  
  
  METHODS
  We reviewed 50 consecutive patients undergoing extrapleural pneumonectomy for malignant pleural mesothelioma in our institution between January 1993 and March 2005.
  
  
  RESULTS
  The median survival was 11 months, with a 3-year survival of 24%. Survival was significantly worse for patients with N2 disease than for those with no lymph node metastasis (median survival 10 months vs 29 months, respectively, P = .005). Patient sex, histologic cell type, stage, and N2 disease, but not mediastinoscopy, had significant impacts on survival according to univariate analysis. In a multivariate analysis, however, only the presence of N2 disease remained a significant predictor of poor outcome. The proportion of patients with N2 disease and the long-term survival was similar regardless of whether preoperative mediastinoscopy yielded a negative result. The initial site of recurrence was determined in 28 patients (locoregional in 10 and distant in 18). The presence of N2 disease had no impact on the site of recurrence. Adjuvant hemithoracic radiation therapy, however, significantly decreased the risk of locoregional recurrence.
  
  
  CONCLUSIONS
  The presence of N2 disease negatively affects the prognosis of patients with malignant pleural mesothelioma. Mediastinoscopy, however, seems to have a limited role in patient selection for extrapleural pneumonectomy. Adjuvant hemithoracic radiation therapy but not N2 disease affects the risk of locoregional recurrence.
authors.affiliation: Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Canada. marc.deperrot@uhn.on.ca
authors.forename: Marc
authors.initials: M
authors.lastname: de Perrot
authors.forename: Karl
authors.initials: K
authors.lastname: Uy
authors.forename: Masaki
authors.initials: M
authors.lastname: Anraku
authors.forename: Ming S
authors.initials: MS
authors.lastname: Tsao
authors.forename: Gail
authors.initials: G
authors.lastname: Darling
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Waddell
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Pierre
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.forename: Michael R
authors.initials: MR
authors.lastname: Johnston
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008481:Mediastinoscopy; D008482:Mediastinum; D008654:Mesothelioma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy; D011379:Prognosis; D015996:Survival Rate