title: Is malignant pleural mesothelioma a surgical disease? A review of 83 consecutive extra-pleural pneumonectomies.
abstract: OBJECTIVE
  To report on the experience with radical surgery, with emphasis on the long-term outcome, for malignant pleural mesothelioma (MPM) at a single institution.
  
  
  METHODS
  From our prospective database over a 17-year period, we reviewed 83 consecutive patients undergoing radical surgery for MPM in a multimodality programme. The long-term overall survival was analysed using the Kaplan-Meier method.
  
  
  RESULTS
  A total of 83 patients (65 males, median age: 60 years) underwent an extra-pleural pneumonectomy (EPP) with a curative intent. Epitheliod MPM was the most frequent (82%) cause. A right-sided disease was present in half of the cases (n=42). The International Mesothelioma Interest Group (IMIG) stage of the disease was 2 in 36%, 3 in 45% and 4 in 9% of the cases. Preoperative chemotherapy consisting of a doublet cisplatin-pemetrexed (mean of three cycles) was offered to 10 patients (12%). Postoperative therapies, either chemotherapy or radiotherapy, were given in 25 patients (30%). The 30-day and 90-day mortality rates were 4.8% and 10.8%, respectively. Postoperative complications occurred in 39.8% and were major in 23 patients (27.7%). Re-operation was necessary in 12 cases (14.5%) for one of the following reasons: broncho-pleural fistula (n=4), bleeding (n=3), diaphragmatic patch rupture (n=3), oesophago-pleural fistula (n=1) and empyaema (n=1). The mean hospital stay was 43 days. The median survival was 14.5 months, while the overall 1-, 2- and 5-year survival rates were 62.4%, 32.2% and 14.3%, respectively.
  
  
  CONCLUSIONS
  These results concur with the published data of the most experienced centre with regards to the mortality and morbidity after EPP for MPM. In line with the biggest series reported in the past, the observed 5-year survival rate of almost 15% is disappointing.
authors.affiliation: The University of the Mediterranean - Assistance Publique & Hôpitaux de Marseille, Marseille, France.
authors.forename: Delphine Sophie
authors.initials: DS
authors.lastname: Trousse
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Avaro
authors.forename: Xavier Benoit
authors.initials: XB
authors.lastname: D'Journo
authors.forename: Christophe
authors.initials: C
authors.lastname: Doddoli
authors.forename: Philippe
authors.initials: P
authors.lastname: Astoul
authors.forename: Roger
authors.initials: R
authors.lastname: Giudicelli
authors.forename: Pierre A
authors.initials: PA
authors.lastname: Fuentes
authors.forename: Pascal Alexandre
authors.initials: PA
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D010994:Pleura / Q000601:surgery; D010997:Pleural Neoplasms / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods*; D011379:Prognosis; D016896:Treatment Outcome