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Is malignant pleural mesothelioma a surgical disease? A review of 83 consecutive extra-pleural pneumonectomies

^a The University of the Mediterranean – Assistance Publique & Hôpitaux de Marseille, Marseille, France
^b Department of Thoracic Surgery, Sainte Marguerite Hospital, Marseille, France
^c Department of Thoracic Oncology, Sainte Marguerite Hospital, Marseille, France

Received 11 November 2008; received in revised form 8 April 2009; accepted 27 April 2009.

^_* Corresponding author. Address: Department of Thoracic Surgery, Sainte Marguerite's Hospital, 270 Bd Sainte Marguerite, 13274 Marseille Cedex 09, France. Tel.: +33 491 744 680; fax: +33 491 744 590. (Email: pathomas{at}ap-hm.fr).

Objective: To report on the experience with radical surgery, with emphasis on the long-term outcome, for malignant pleural mesothelioma (MPM) at a single institution. Methods: From our prospective database over a 17-year period, we reviewed 83 consecutive patients undergoing radical surgery for MPM in a multimodality programme. The long-term overall survival was analysed using the Kaplan–Meier method. Results: A total of 83 patients (65 males, median age: 60 years) underwent an extra-pleural pneumonectomy (EPP) with a curative intent. Epitheliod MPM was the most frequent (82%) cause. A right-sided disease was present in half of the cases (n = 42). The International Mesothelioma Interest Group (IMIG) stage of the disease was 2 in 36%, 3 in 45% and 4 in 9% of the cases. Preoperative chemotherapy consisting of a doublet cisplatin–pemetrexed (mean of three cycles) was offered to 10 patients (12%). Postoperative therapies, either chemotherapy or radiotherapy, were given in 25 patients (30%). The 30-day and 90-day mortality rates were 4.8% and 10.8%, respectively. Postoperative complications occurred in 39.8% and were major in 23 patients (27.7%). Re-operation was necessary in 12 cases (14.5%) for one of the following reasons: broncho-pleural fistula (n = 4), bleeding (n = 3), diaphragmatic patch rupture (n = 3), oesophago-pleural fistula (n = 1) and empyaema (n = 1). The mean hospital stay was 43 days. The median survival was 14.5 months, while the overall 1-, 2- and 5-year survival rates were 62.4%, 32.2% and 14.3%, respectively. Conclusions: These results concur with the published data of the most experienced centre with regards to the mortality and morbidity after EPP for MPM. In line with the biggest series reported in the past, the observed 5-year survival rate of almost 15% is disappointing.

Key Words: Extra-pleural pneumonectomy • Malignant pleural mesothelioma • Overall survival • Prognostic factors