Outcome after extrapleural pneumonectomy for malignant pleural mesothelioma.
BACKGROUND
Malignant pleural mesothelioma is a mainly asbestos-related neoplasm that occurs with increasing frequency and is associated with a poor prognosis. Extrapleural pneumonectomy which was initially performed as a stand-alone treatment in patients with resectable disease is now currently almost uniformly applied as part of a multi-modal approach. Its value and advantage over other therapeutic strategies remain points of discussion. We therefore analysed our experience with extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma.


METHODS
We retrospectively reviewed our institutional experience with all consecutive patients undergoing extrapleural pneumonectomy for malignant pleural mesothelioma from 1994 to 2005. Patients were analysed with regard to hospital mortality and morbidity and long-term outcome.


RESULTS
Forty-nine patients (10 female/39 male, mean age 58+12 years) underwent extrapleural pneumonectomy during the observation period. Median ICU stay was 1 day, median postoperative length of hospital stay was 13 days. After a mean follow-up of 2573 days, median survival was 376 days (mean 672+121 days, range 9-3384). One-year survival was 53%, 3-year survival 27% and 5-year survival 19%.


CONCLUSIONS
Extrapleural pneumonectomy as part of a multi-modality treatment regimen is a good treatment option for selected patients with malignant pleural mesothelioma. The long-term results of this limited series compare favourably to non-surgical treatment regimens. Larger randomised prospective multi-centre trials are warranted to establish clear guidelines.
Aigner
Clemens
C
Department of Cardio-Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Hoda
Mir Ali Reza
MA
Lang
Gyoergy
G
Taghavi
Shahrokh
S
Marta
Gabriel
G
Klepetko
Walter
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008875:Middle Aged; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D011013:Pneumonectomy / Q000379:methods*; D016896:Treatment Outcome