The effect of extent of local resection on patterns of disease progression in malignant pleural mesothelioma

Stewart, Duncan J., Martin-Ucar, Antonio E., Pilling, John E., Edwards, John G., O'Byrne, Kenneth J., & Waller, David A. (2004) The effect of extent of local resection on patterns of disease progression in malignant pleural mesothelioma. Annals of Thoracic Surgery, 78(1), pp. 245-252.

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Abstract

Background We sought to determine whether or not there are differences in disease progression after radical or nonradical (debulking) surgical procedures for malignant pleural mesothelioma.

Methods Over a 49-month period, 132 patients with malignant pleural mesothelioma underwent surgery. Fifty-three underwent extrapleural pneumonectomy and 79 underwent nonradical procedures. Time to evidence of clinical disease progression was recorded, as was the site(s) of that disease.

Results One-hundred nineteen patients were evaluable, of which 59% (22 radical; 48 nonradical) had disease progression. Overall 30-day mortality was 8.5% (7.5% radical; 9% nonradical). The median time to overall disease progression was considerably longer after extrapleural pneumonectomy than debulking surgery (319 days vs 197 days, p = 0.019), as was the time to local disease progression (631 days vs 218 days, p = 0.0018). There was no preponderance of earlier stage disease in the radical surgery group. There was a trend toward prolonged survival in those undergoing radical surgery, but no significant difference between the groups (497 days vs 324 days, p = 0.079). In those who had extrapleural pneumonectomy, time-to-disease progression significantly decreased with N2 disease compared with N0/1 involvement (197 days vs 358 days, p = 0.02).

Conclusions Extrapleural pneumonectomy may be preferable to debulking surgery in malignant pleural mesothelioma to delay disease progression and give greater control of local disease. Involvement of N2 nodes is associated with accelerated disease progression and is therefore a contraindication to extrapleural pneumonectomy. © 2004 by The Society of Thoracic Surgeons.

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ID Code: 65715
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: 14, article, cancer control, cancer surgery, comparative study, disease course, female, human, lung resection, major clinical study, male, mesothelioma, mortality, priority journal, statistical significance, surgical technique, tumor localization, Abdominal Neoplasms, Adult, Aged, Antineoplastic Combined Chemotherapy Protocols, Cisplatin, Combined Modality Therapy, Deoxycytidine, Diaphragm, Disease Progression, Follow-Up Studies, Humans, Lymph Node Excision, Lymphatic Metastasis, Middle Aged, Neoadjuvant Therapy, Neoplasm Invasiveness, Pericardium, Pleural Neoplasms, Pneumonectomy, Prognosis, Prostheses and Implants, Radiotherapy, Adjuvant, Surgical Mesh, Survival Analysis, Thoracic Surgery, Video-Assisted, Treatment Outcome
DOI: 10.1016/j.athoracsur.2004.01.034
ISSN: 0003-4975
Divisions: Current > Schools > School of Biomedical Sciences
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2004 Elsevier Inc.
Deposited On: 06 Jan 2014 07:04
Last Modified: 08 Jan 2014 22:47

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