Extrapleural pneumonectomy or vats pleurectomy / decortication for early stage malignant mesothelioma? A case control study

PURPOSE: To examine whether radical surgery has benefits over debulking for malignant pleural mesothelioma (MM), we compared the results of extrapleural pneumonectomy (EPP) and VATS pleurectomy / decortication (P/D) in a case control study.

METHODS: We analysed the results of EPP or P/D in 145 consecutive patients with early stage MM over a seven year period. If deemed medically fit, patients received EPP. Those unfit underwent P/D (a subtotal parietal pleurectomy followed by visceral decortication to

gain full lung expansion). The distribution of known prognostic factors between the groups was compared. Postoperative survival and time to progression (TTP) data were analysed.

RESULTS: EPP was performed in 95 and P/D in 50 patients. Those in the P/D group were older (median age 68 vs. 57 years, p<0.001), p="0.001)" p="0.002)" p="0.03)." p="0.001)." p="0.48)." p="0.03)" p="0.5)." p="0.01).">

CONCLUSION: Radical surgery (EPP) for mesothelioma may achieve better local control than debulking surgery but tiffs has not been shown to influence distant disease progression or survival. However, survival following VATS P/D appears to be no better than for the N2 positive EPP group.

CLINICAL IMPLICATIONS: We conclude that the role of EPP should be subject to evaluation in a randomised trial.

DISCLOSURE: Antonio Martin-Ucar, None.

John G. Edwards PhD Antonio E. Martin-Ucar MD * Duncan J. Stewart MBBS David A. Waller Glenfield Hospital, Leicester, United Kingdom

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group