Radical pleurectomy/decortication saves patients bypassed by EPP

October 16, 2008

This article discusses a study that showed the effectiveness of open chest radical pleurectomy decortication  (PD) surgery compared to open chest palliative PD for patients who were not eligible for EPP.


Cancer commentary #1

March 14, 2008

Patient “M.N.”

Do not accept the first thing you’re told if something inside you rebels. I went to my family doctor in 2006 only to have my complaints ignored. “You’re stressed out,” and “Take some time off,” was the best I could get. Excuse me, Mr. MD, but my cancer wasn’t taking any time off. It was spreading like wildfire.

You have to listen to your inner voice, and I didn’t listen to mine. I listened to the words of an expert, who it turns out wasn’t an expert at all. He’d never seen a case of mesothelioma in 25 years. Because I was only 32 nobody pushed to get real answers.

But nothing in life is all good or all bad. It varies depending on your mood, your situation, and the ebb and flow of the illness itself. My cancer brought me closer to my family. I learned who my friends were, and I cherish them now. I have changed my approach to life, because there’s so much less of it left. The minutes, the seconds, really do matter, and the funny thing is, they mattered all along—it just took a terrible disease to show me. The me that used to hold grudges is gone, or rather the grudges are gone, replaced with a funny kind of clearness.

P/D v. EPP: results in 663 patients

March 12, 2008

OBJECTIVE: The optimal procedure for resection of malignant pleural mesothelioma is controversial, partly because previous analyses include small numbers of patients. We performed a multi-institutional study to increase statistical power to detect significant differences in outcome between extrapleural pneumonectomy and pleurectomy/decortication.

METHODS: Patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy or pleurectomy/decortication at 3 institutions were identified. Survival and prognostic factors were analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis.

RESULTS: From 1990 to 2006, 663 consecutive patients (538 men and 125 women) underwent resection. The median age was 63 years (range, 26-93 years). The operative mortality was 7% for extrapleural pneumonectomy (n = 27/385) and 4% for pleurectomy/decortication (n = 13/278). Significant survival differences were seen for American Joint Committee on Cancer stages 1 to 4 (P < .001), epithelioid versus non-epithelioid histology (P < .001), extrapleural pneumonectomy versus pleurectomy/decortication (P < .001), multimodality therapy versus surgery alone (P < .001), and gender (P < .001). Multivariate analysis demonstrated a hazard rate of 1.4 for extrapleural pneumonectomy (P < .001) controlling for stage, histology, gender, and multimodality therapy.

CONCLUSION: Patients who underwent pleurectomy/decortication had a better survival than those who underwent extrapleural pneumonectomy; however, the reasons are multifactorial and subject to selection bias. At present, the choice of resection should be tailored to the extent of disease, patient comorbidities, and type of multimodality therapy planned.

J Thorac Cardiovasc Surg. 2008 Mar;135(3):620-626.e3. Epub 2008 Feb 14
Flores RM, Pass HI, Seshan VE, Dycoco J, Zakowski M, Carbone M, Bains MS, Rusch VW.
Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.

PMID: 18329481 [PubMed – in process]