Improved survival with VATS pleurectomy-decortication in advanced malignant mesothelioma


Halstead, JC; Lim, E; Venkateswaran, RM; Charman, SC; Goddard, M; Ritchie, AJ; (2005) Improved survival with VATS pleurectomy-decortication in advanced malignant mesothelioma. European journal of surgical oncology, 31 (3). pp. 314-20. ISSN 0748-7983 DOI: https://doi.org/10.1016/j.ejso.2004.08.014

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Abstract

AIMS: Malignant mesothelioma is increasing in incidence and no current therapy significantly prolongs survival. Previous surgical strategies involved high-risk open procedures without achieving histologically clear resection margins. We present the results of VATS debulking pleurectomy-decortication in advanced disease. METHODS: A consecutive series of patients with suspected malignant mesothelioma underwent thoracoscopic assessment to determine the feasibility of decortication, where this was not possible a biopsy alone was taken. Post-operative radiotherapy was administered to port sites, but no other adjuvant therapy was given. The two groups (biopsy only and pleurectomy-decortication) were composed of patients with histologically confirmed mesothelioma [28 and 51 patients, respectively]. The primary endpoint was comparison of actuarial patient survival. Secondary endpoints included post-operative air leak and duration of hospital stay. RESULTS: The overall actuarial survival was 288 days and 67% of patients had died at the time of data analysis. The groups were matched for patient and tumour-related characteristics including age (66, 64 years, p=0.39) and tumour stage (median IMIG stage 3 [IQR 2-3] both groups, p=0.54). The biopsy only group had fewer air leaks (57, 84%, p=0.01) and a shorter hospital stay (4, 8 days, p=0.03). However, the pleurectomy-decortication group had favourable actuarial survival relative to the biopsy only group (416, 127 days, p<0.001). Multivariate analysis showed early stage (p<0.001), absence of pre-operative fever (p=0.03) and pleurectomy-decortication (p<0.001) as independent predictors of survival. CONCLUSION: VATS pleurectomy-decortication is feasible in the majority of cases and independently improves survival for patients with advanced malignant mesothelioma.

Item Type: Article
Keywords: Actuarial Analysis, Aged, Feasibility Studies, Humans, Male, Mesothelioma/mortality/pathology/*surgery, Middle Aged, Multivariate Analysis, Neoplasm Staging, Pleural Neoplasms/mortality/pathology/*surgery, Proportional Hazards Models, Survival Analysis, *Thoracic Surgery, Video-Assisted, Treatment Outcome, Actuarial Analysis, Aged, Feasibility Studies, Humans, Male, Mesothelioma, mortality, pathology, surgery, Middle Aged, Multivariate Analysis, Neoplasm Staging, Pleural Neoplasms, mortality, pathology, surgery, Proportional Hazards Models, Survival Analysis, Thoracic Surgery, Video-Assisted, Treatment Outcome
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 15780570
Web of Science ID: 228260300019
URI: http://researchonline.lshtm.ac.uk/id/eprint/3012

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