HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Giuliano Maggi Caterina Casadio Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Maggi, G. Articles by Rena, O. Search for Related Content PubMed PubMed Citation Articles by Maggi, G. Articles by Rena, O.

Eur J Cardiothorac Surg 2002;21:1128
© 2002 Elsevier Science NL

Letter to the Editor

Palliative surgery for malignant pleural mesothelioma

Division of General Thoracic Surgery, Thoracic Surgery Department, University of Torino, San Giovanni Battista Hospital, Via Millefonti 39/1, 10126 Turin, Italy

Received 15 March 2002; accepted 22 March 2002.

* Corresponding author. Tel.: +39-11-633-663555; fax: +39-11-696-0170
e-mail: giuliano.maggi{at}unito.it

We read with interest the excellent paper of A.E. Martin-Ucar et al. [1], regarding the palliative debulking surgery for the treatment of the malignant pleural mesothelioma (MPM). We have two questions:

1. Were the authors able to obtain the parietal pleurectomy by VATS in all cases or was it unpractical in some patients, because the tumour was too adherent or too bleeding?
   
2. Doesn't it seem to the authors that a palliative decortication of a not expandable lung, obtained via thoracotomy, perhaps is a too severe operation, considering that the persistent air leak rate, longer than 7 days, was 15%, and the 6-week mortality rate was 14%?
   

In the last 3 years we performed 52 thoracotomies for MPM (pleurectomy/decortication in 14 patients and extrapleural pneumonectomy in 38 patients), but we observed only four out of 52 patients having a thin parietal pleura (7.6%).

We feel that the palliative procedures, presented in the authors’ important series, are safe and feasible in a limited number of unresectable MPM, while the majority of MPM patients have a thick cortex; in these cases the parietal pleura affected by MPM is hard, sometimes very adherent to the thoracic wall tissues, with a rich vascularization which requires a meticulous and difficult coagulation: we think that these tumours are not easily resectable by VATS, as pointed out in the discussion of Grossebner et al. [2] at the Brussels EACTS Congress in 1998.

In our experience, decortication of the visceral pleura affected by MPM is ever related with lung parenchymal damage with important air leaks, because there is never a free space between the tumour and the underlying pulmonary tissue. Air leaks and bleeding from the lung are sometimes important even if a meticulous control with stitches or glues is carried out.

References

1. Martin-Ucar A.E., Edwards J.G., Rengajaran A., Muller S., Waller D.A. Palliative surgical debulking in malignant mesothelioma. Predictor of survival and symptom control. Eur J Cardothorac Surg 2001;20:1117-1121.[Abstract/Free Full Text]
2. Grossebner M., Arifi A.A., Goddart M., Ritchie A.J. Mesothelioma VATS biopsy and lung mobilization improves diagnosis and palliation. Eur J Cardiothorac Surg 1999;16:619-623.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Giuliano Maggi Caterina Casadio Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Maggi, G. Articles by Rena, O. Search for Related Content PubMed PubMed Citation Articles by Maggi, G. Articles by Rena, O.