Eur J Cardiothorac Surg 2003;23:255
© 2003 Elsevier Science NL
The management of malignant pleural mesothelioma
Giuliano Maggi*,
Caterina Casadio,
Roberto Giobbe,
Enrico Ruffini
Thoracic Surgery Department, San Giovanni Battista Hospital, Via Genova 3, 10126 Turin, Italy
Received 28 September 2002;
received in revised form 28 September 2002;
accepted 28 October 2002.
* Corresponding author. Tel.: +39-11-633-6635; fax: +39-11-696-0170
e-mail: giuliano.maggi{at}unito.it
Key Words: Malignant pleural mesothelioma • Diagnosis
We read with interest the excellent paper of Aziz and colleagues presented by Dr. Prakash at the 2001 EACTS/ESTS Meeting in Lisbon [1]. We have three questions for the authors which we would like to be addressed:
- The Authors performed 47 decortications/pleurectomies (D/P) and 64 extrapleural pneumonectomies (EPP): we assume that the authors consider D/P only as palliative treatment for a ‘locally extensive disease’ otherwise not suitable for curative surgery. In our series of 65 patients operated on in the last 4 years, we were able to perform 48 EPP, 11 palliative D/P and six radical D/P in patients with Stage T1a (two cases) or T1b (four cases), thus sparing the lung when the visceral pleura was not involved. At a median follow-up of 48 months the patients submitted to radical D/P do not present sign of loco-regional recurrence and present a survival comparable to patients receiving EPP. Did the Authors ever consider a radical D/P in the early stages without involvement of the visceral pleura?
- The Authors obtained a preoperative diagnosis by open pleural biopsy. Did they consider thoracoscopy in the preoperative diagnosis of mesothelioma in patients with pleural effusion?
- In the Discussion, Dr. Prakash states that in the presence of peritoneal involvement the outcome of the patients is poor. Subdiaphragmatic involvement is often difficult to ascertain with standard radiological techniques. MRI and PET scan looks promising but they lack sufficient clinical evidence. We perform laparoscopy when a diaphragmatic invasion is suspected at MRI: did the authors ever consider laparoscopy in these suspected cases?
Again, the authors have to be congratulated for this excellent paper on such a difficult surgical technique.
References
- Aziz T., Jilaihawi A., Prakash D. The management of malignant pleural mesothelioma. Single centre experience in 10 years. Eur J Cardiothorac Surg 2002;22:298-305.[Abstract/Free Full Text]
