Purpose: Malignant pleural mesothelioma (MPM) is a locally aggressive neoplasm with a poor prognosis. Extra pleural pneumonectomy (EPP) seems to improve long-term results in terms of local control and survival. We analyze surgical results of our experience in the treatment of MPM. Methods: We retrospectively reviewed patients with MPM operated on between 2003 and 2010 receiving one of the following surgical procedures: a) EPP, b) pleurectomy/decortication (PD), c) VATS/talc poudrage (VTP), or)xploratory thoracotomy (ET). Results: 146 patients with MPM underwent a surgical treatment: 47 EPP, 9 PD, 73 VTP, and 17 TE. There were 106 males; median age was 65 years (range, 41-87 years). Histology was epithelioid in 124 patients, biphasic in 12, and sarcomatoid in 10. Platin based chemotherapy was administered in 73 patients (50%) (17 ET, 47 EPP, 4 PD, 5 VTP). Thirty-day mortality was 5.4% (8/146) (5 EPP, 1 PD, 2 VTP); 30-day morbidity rate was 18.5% (27/146) all occurring in the EPP and ET groups. Major complications occurred in 21 (hemothorax in 8 patients, chylothorax, diaphragmatic hernia and BPF, ARDS in 3 cases, each, and esophageal fistula in 1) and minor in 6 (arrhythmias). Late major complications occurred in 4 cases: 3 BPF and one esophageal fistula. Overall 3- and 5-year survivals were 20% and 7% with a median survival of 16 months. 4-year survival was better for the EPP group (19%) versus VTP (10%) even if statistically not significant. No patient of TE and PD group was alive at 3 years. Histology significantly influenced survival (13% for epithelioid at 4-years, no patient alive at 2 years for biphasic and at 4 years for sarcomatoid, p= 0.0035). Conclusions: EPP remains the best surgical procedure in terms of long-term results for patients with MPM. Patients with the epithelioid form have the best prognosis. Postoperative mortality is acceptable even if the rate of postoperative surgical complications remains high
Malignant pleural mesothelioma: what is the best treatment option? A single- institution experience / D. Galetta, A. Borri, A. Pardolesi, R. Gasparri, F. Petrella, P. Solli, A. Tessitore, M. Casiraghi, L. Spaggiari. ((Intervento presentato al 48. convegno STS tenutosi a Fort Lauderdale nel 2012.
Malignant pleural mesothelioma: what is the best treatment option? A single- institution experience
D. Galetta;F. Petrella;M. Casiraghi;L. Spaggiari
2012
Abstract
Purpose: Malignant pleural mesothelioma (MPM) is a locally aggressive neoplasm with a poor prognosis. Extra pleural pneumonectomy (EPP) seems to improve long-term results in terms of local control and survival. We analyze surgical results of our experience in the treatment of MPM. Methods: We retrospectively reviewed patients with MPM operated on between 2003 and 2010 receiving one of the following surgical procedures: a) EPP, b) pleurectomy/decortication (PD), c) VATS/talc poudrage (VTP), or)xploratory thoracotomy (ET). Results: 146 patients with MPM underwent a surgical treatment: 47 EPP, 9 PD, 73 VTP, and 17 TE. There were 106 males; median age was 65 years (range, 41-87 years). Histology was epithelioid in 124 patients, biphasic in 12, and sarcomatoid in 10. Platin based chemotherapy was administered in 73 patients (50%) (17 ET, 47 EPP, 4 PD, 5 VTP). Thirty-day mortality was 5.4% (8/146) (5 EPP, 1 PD, 2 VTP); 30-day morbidity rate was 18.5% (27/146) all occurring in the EPP and ET groups. Major complications occurred in 21 (hemothorax in 8 patients, chylothorax, diaphragmatic hernia and BPF, ARDS in 3 cases, each, and esophageal fistula in 1) and minor in 6 (arrhythmias). Late major complications occurred in 4 cases: 3 BPF and one esophageal fistula. Overall 3- and 5-year survivals were 20% and 7% with a median survival of 16 months. 4-year survival was better for the EPP group (19%) versus VTP (10%) even if statistically not significant. No patient of TE and PD group was alive at 3 years. Histology significantly influenced survival (13% for epithelioid at 4-years, no patient alive at 2 years for biphasic and at 4 years for sarcomatoid, p= 0.0035). Conclusions: EPP remains the best surgical procedure in terms of long-term results for patients with MPM. Patients with the epithelioid form have the best prognosis. Postoperative mortality is acceptable even if the rate of postoperative surgical complications remains high
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