Online citations, reference lists, and bibliographies.
← Back to Search

Morbidity, Mortality, Mean Survival, And The Impact Of Histology On Survival After Pleurectomy In 64 Patients With Malignant Pleural Mesothelioma.

S. Neragi-Miandoab, W. Richards, D. Sugarbaker
Published 2008 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
AIM The survival of patients with malignant pleural mesothelioma (MPM) who do not seek treatment ranges from 4 to 12 months. To date, the optimal procedure for resection of malignant pleural mesothelioma is controversial, extrapleural pneumonectomy has been most consistently associated with long-term survival and has provided the most radical cytoreduction; but, unfortunately, not all patients qualify for this invasive surgical approach. METHODS Between 1992 and 2000, 64 patients underwent pleurectomy as a palliative treatment for MPM. This retrospective study evaluates the operative outcome and the impact of some prognostic factors on patients' survival. Preoperative evaluation included chest X-ray, CT and/or MRI. Diagnosis was made by pleural biopsy via needle, open, or VATS biopsy. The Kaplan-Meier curve and the Log-Rank test were used to analyze the data. RESULTS The median age of the study group was 65 (with a range of 29-84 years). Thirty-six patients had epithelial histology, and 28 patients had sarcomatoid or mixed type (e.g., epithelial+spindle, epithelial+sarcomatoid). The 30-day mortality rate was 3.1%. The overall survival rate was 43%, 28%, and 10% at 1, 2, and 3 years, respectively. The overall median survival was 9.4 months (ranging from 1.15 to 52.7 months). The overall median survival with epithelial histology (n=36, 56%) was 21.7 months (with a range of 1.4-52.7 months) versus 5.8 months (with a range of 1.15-18.3 months) for the sarcomatoid or mixed type (n=28, 44%), p=0.0001. The morbidity included atrial fibrillation (n=5), wound infection (n=2), prolonged intubation (longer than 24h, n=8), reintubation for respiratory failure (n=2), pulmonary emboli (n=1), UTI (n=16), DVT (n=5), MI (n=4), and postoperative bleeding (n=7). Univariant analysis demonstrated that the only prognostic factors influencing survival in our series was the histologic type. Age, gender, and the affected side of the lung did not affect the median survival. CONCLUSION Our results show that pleurectomy can be performed as a means of palliation for advanced-stage disease with a low mortality rate and may, in fact, improve survival in patients with epithelial subtype as compared with historical controls in the literature with no surgical intervention.
This paper references
A phase II study of intrapleural immuno-chemotherapy, pleurectomy/decortication, radiotherapy, systemic chemotherapy and long-term sub-cutaneous IL-2 in stage II-III malignant pleural mesothelioma.
M. Lucchi (2007)
Improved survival with VATS pleurectomy-decortication in advanced malignant mesothelioma.
J. Halstead (2005)
The diagnosis, therapy and prognosis of diffuse malignant mesothelioma.
R. Achatzy (1989)
Operation and photodynamic therapy for pleural mesothelioma: 6-year follow-up.
T. L. Moskal (1998)
The management of malignant pleural mesothelioma; single centre experience in 10 years.
T. Aziz (2002)
Treatment of mesothelioma in Bloemfontein, South Africa.
W. de Vries (2003)
Malignant pleural mesothelioma: surgical management in 285 patients.
P. Schipper (2008)
The management of malignant pleural mesothelioma.
G. Maggi (2003)
Survival after conservative (palliative) management of pleural malignant mesothelioma
N. Merritt (2001)
Multimodality management of malignant pleural mesothelioma.
D. Sugarbaker (1998)
Important prognostic factors in patients with malignant pleural mesothelioma, managed surgically.
V. Rusch (1999)
Pleurectomy and intraoperative brachytherapy and postoperative radiation in the treatment of malignant pleural mesothelioma.
B. Hilaris (1984)
Therapeutic outcome according to histologic subtype in 121 patients with malignant pleural mesothelioma.
G. Ceresoli (2001)
Clinical features and current treatment of diffuse malignant pleural mesothelioma.
V. Rusch (1995)
Pleurectomy for mesothelioma
R. Brancatisano (1991)
Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients.
R. Flores (2008)
Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women's Hospital experience over two decades, 1965-1985.
K. Antman (1988)
Malignant mesothelioma of the pleura: a study of 52 treated and 64 untreated patients.
M. Law (1984)
Surgically debulked malignant pleural mesothelioma: Results and prognostic factors
H. Pass (2006)
Palliative surgical debulking in malignant mesothelioma. Predictors of survival and symptom control.
A. Martin-Ucar (2001)
Pleurectomy/decortication in the setting of multimodality treatment for diffuse malignant pleural mesothelioma.
V. Rusch (1997)
Malignant pleural mesothelioma in western Glasgow 1980-6.
G. Hulks (1989)
A phase II trial of pleurectomy/decortication followed by intrapleural and systemic chemotherapy for malignant pleural mesothelioma.
V. Rusch (1994)
Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients.
D. Sugarbaker (1999)
Radical surgery for malignant pleural mesothelioma: results and prognosis.
M. Okada (2008)
Conventional treatment and its effect on survival of malignant pleural mesothelioma in Western Australia.
A. Musk (1982)
Preoperative tumor volume is associated with outcome in malignant pleural mesothelioma.
H. Pass (1998)
Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients.
P. Ruffié (1989)
Pleurectomy/decortication for palliation in malignant pleural mesothelioma: results of surgery.
O. Soysal (1997)
Mesothelioma: new concepts in diagnosis and management
A. Boylan (2000)

This paper is referenced by
Diagnostic value of biopsy sampling in predicting histology in patients with diffuse malignant pleural mesothelioma
L. Chirieac (2019)
Incidence of atrial fibrillation after extrapleural pneumonectomy vs. pleurectomy in patients with malignant pleural mesothelioma.
S. Neragi-Miandoab (2008)
PAX8 Reliably Distinguishes Ovarian Serous Tumors From Malignant Mesothelioma
Anna R. Laury (2010)
Institutional report - Thoracic general Incidence of atrial fibrillation after extrapleural pneumonectomy vs. pleurectomy in patients with malignant pleural mesothelioma
S. Neragi-Miandoab (2008)
Belmont™ Hyperthermia Pump in the conduct of intra-operative heated chemotherapy
W. Riley (2009)
The diagnostic and molecular characteristics of malignant mesothelioma and ovarian/peritoneal serous carcinoma
B. Davidson (2011)
Circulating tumor cells as a diagnostic test for malignant pleural mesothelioma.
G. Pinton (2012)
Predicting survival in malignant mesothelioma
A. Musk (2011)
Practical approaches to diagnose and treat for T0 malignant pleural mesothelioma: a proposal for diagnostic total parietal pleurectomy
S. Hasegawa (2011)
Analysis of Expression of Programmed Cell Death 1 Ligand 1 (PD-L1) in Malignant Pleural Mesothelioma (MPM)
S. Cedrés (2015)
Pleurectomy/Decortication is Superior to Extrapleural Pneumonectomy in the Multimodality Management of Patients with Malignant Pleural Mesothelioma
L. Lang-Lazdunski (2012)
Malignant Pleural Mesothelioma
S. Raja (2011)
Practical approaches to diagnose and treat for T0 malignant pleural mesothelioma: a proposal for diagnostic total parietal pleurectomy
Seiki HasegawaNobuyuki (2012)
Surgery for malignant pleural mesothelioma
Michael A. Archer (2015)
Cyclooxygenase-2, Epidermal Growth Factor Receptor, and Aromatase Signaling in Inflammation and Mesothelioma
B. Nuvoli (2013)
Extrapleural pneumonectomy (EPP) vs. pleurectomy decortication (P/D).
H. Batırel (2017)
Video-assisted thoracoscopic surgery in the management of malignant pleural disease
G. Luciano (2018)
The Role of Cyclooxygenase-2, Epidermal Growth Factor Receptor and Aromatase in Malignant Mesothelioma
R. Galati (2012)
Sarcomatoid mesothelioma: a clinical–pathologic correlation of 326 cases
S. Klebe (2010)
Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma
T. Tanaka (2017)
Pleurectomy/Decortication, Hyperthermic Pleural Lavage with Povidone-Iodine Followed by Adjuvant Chemotherapy in Patients with Malignant Pleural Mesothelioma
L. Lang-Lazdunski (2011)
Does Surgery Improve Survival of Patients with Malignant Pleural Mesothelioma?: A Multicenter Retrospective Analysis of 1365 Consecutive Patients
P. Bovolato (2014)
Malignant Mesothelioma: Pathology
S. Anttila (2014)
Scuola di Dottorato in Scienze Fisiopatologiche e neuropsicobiologiche e assistenziali del ciclo della vita - Ciclo XXVIII
Roberto Weinstein (2015)
Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine, prophylactic radiotherapy, and systemic chemotherapy in patients with malignant pleural mesothelioma: a 10-year experience.
L. Lang-Lazdunski (2015)
Systematic review of pleurectomy in the treatment of malignant pleural mesothelioma.
C. Cao (2013)
The diagnosis of malignant mesothelioma in effusion cytology
A. Paintal (2013)
Physical function and health-related quality of life in the convalescent phase in surgically treated patients with malignant pleural mesothelioma
T. Tanaka (2019)
Surgery in Malignant Pleural Mesothelioma
R. Bueno (2018)
Aromatase Inhibitor Exemestane has Antiproliferative Effects on Human Mesothelioma Cells
D. Stoppoloni (2011)
Complete response and long-term survival in malignant pleural mesothelioma: case report.
S. Takanen (2012)
Surgical and Medical Therapy for Malignant Pleural Mesothelioma
C. Cao (2014)
See more
Semantic Scholar Logo Some data provided by SemanticScholar