| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2001;20:1117-1121
© 2001 Elsevier Science NL
a Department of Thoracic Surgery, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
b Department of Pathology, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
Received 11 June 2001; received in revised form 4 August 2001; accepted 3 September 2001.
Corresponding author. Tel.: +44-116-256-3959; fax: +44-116-236-7768
e-mail: debra.grew{at}uhl-tr.nhs.uk
Objective: Malignant mesothelioma (MM) typically presents at an advanced stage. In the UK surgical intervention has been mostly reserved for tissue diagnosis or chemical pleurodesis. However, the role of debulking surgery in symptom control has not been fully explored. Methods: In a prospective cohort study, 51 consecutive patients presenting with MM underwent palliative surgical debulking for symptomatic relief (all patients presented with dyspnoea, 39 also had pain and two had a co-existing pleural empyema). Patients with early disease who underwent extrapleural pneumonectomy were excluded. The treatment aims were pleural drainage, lung re-expansion, pleurodesis and pleural debulking for symptom control. If the lung re-expanded after drainage of the effusion a subtotal parietal pleurectomy was performed via Video Assisted Thoracic Surgery (VATS). If the lung remained entrapped, a parietal and visceral decortication using VATS or thoracotomy was performed. The changes in subjective dyspnoea and pain scores were recorded at 6 weeks and 3, 6 and 12 months after surgery. Prognostic factors were analyzed to determine their influence on survival and symptom control. Results: VATS pleurectomy was possible in 17 patients (34%), whilst decortication was required in the remainder (three by VATS and 31 by thoracotomy). Median postoperative stay was 7 days (range 2–17) with 30-day mortality of 7.8% (four of 51 patients). Morbidity included postoperative empyema in two patients (4%) and prolonged air-leak in five (9.8%). Overall significant symptomatic benefit was obtained up to 3 months after surgery but subsequently increasing mortality offset these benefits. Epithelial cell type and absence of weight loss prior to surgery were found to predict longer survival and successful symptom control. Conclusions: Debulking surgery has a beneficial role in symptom control for unresectable MM. However, this surgery should be reserved for those patients who present with epithelial cell type and before significant loss of weight.
Key Words: Malignant pleural mesothelioma • Video assisted thoracoscopic surgery • Decortication • Trapped lung
This article has been cited by other articles:
|
|
 |
|
  A. Nakas, D. S. Trousse, A. E. Martin-Ucar, and D. A. Waller Open lung-sparing surgery for malignant pleural mesothelioma: the benefits of a radical approach within multimodality therapy Eur. J. Cardiothorac. Surg., October 1, 2008; 34(4): 886 - 891. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Nakas, A. E. Martin Ucar, J. G. Edwards, and D. A. Waller The role of video assisted thoracoscopic pleurectomy/decortication in the therapeutic management of malignant pleural mesothelioma Eur. J. Cardiothorac. Surg., January 1, 2008; 33(1): 83 - 88. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. L. Ceresoli, C. Gridelli, and A. Santoro Multidisciplinary Treatment of Malignant Pleural Mesothelioma Oncologist, July 1, 2007; 12(7): 850 - 863. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. G. Richards, L. Zellos, R. Bueno, M. T. Jaklitsch, P. A. Janne, L. R. Chirieac, B. Y. Yeap, R. J. Dekkers, P. M. Hartigan, L. Capalbo, et al. Phase I to II Study of Pleurectomy/Decortication and Intraoperative Intracavitary Hyperthermic Cisplatin Lavage for Mesothelioma J. Clin. Oncol., April 1, 2006; 24(10): 1561 - 1567. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Neragi-Miandoab Multimodality approach in management of malignant pleural mesothelioma Eur. J. Cardiothorac. Surg., January 1, 2006; 29(1): 14 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Stewart, A. Martin-Ucar, J. E. Pilling, J. G. Edwards, K. J. O'Byrne, and D. A. Waller The effect of extent of local resection on patterns of disease progression in malignant pleural mesothelioma Ann. Thorac. Surg., July 1, 2004; 78(1): 245 - 252. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Kruklitis, S. Singhal, P. Delong, V. Kapoor, D. H. Sterman, L. R. Kaiser, and S. M. Albelda Immuno-gene therapy with interferon-{beta} before surgical debulking delays recurrence and improves survival in a murine model of malignant mesothelioma J. Thorac. Cardiovasc. Surg., January 1, 2004; 127(1): 123 - 130. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Stewart, D. Waller, J. Edwards, K. Jeyapalan, and J. Entwisle Is there a role for pre-operative contrast-enhanced magnetic resonance imaging for radical surgery in malignant pleural mesothelioma? Eur. J. Cardiothorac. Surg., December 1, 2003; 24(6): 1019 - 1024. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. DeLong, T. Tanaka, R. Kruklitis, A. C. Henry, V. Kapoor, L. R. Kaiser, D. H. Sterman, and S. M. Albelda Use of Cyclooxygenase-2 Inhibition to Enhance the Efficacy of Immunotherapy Cancer Res., November 15, 2003; 63(22): 7845 - 7852. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. G. Edwards, D. E. B. Swinson, J. L. Jones, S. Muller, D. A. Waller, and K. J. O'Byrne Tumor Necrosis Correlates With Angiogenesis and Is a Predictor of Poor Prognosis in Malignant Mesothelioma Chest, November 1, 2003; 124(5): 1916 - 1923. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Maggi, R. Giobbe, C. Casadio, and O. Rena Palliative surgery for malignant pleural mesothelioma Eur. J. Cardiothorac. Surg., June 1, 2002; 21(6): 1128 - 1128. [Full Text] [PDF]
|
|
|
|
|
|
A.E. Martin-Ucar, J.G. Edwards, A. Rengarajan, S. Muller, and D.A. Waller Reply to Maggi et al. Eur. J. Cardiothorac. Surg., June 1, 2002; 21(6): 1128 - 1129. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
