Improved survival with VATS pleurectomy-decortication in advanced malignant mesothelioma.

Title
Improved survival with VATS pleurectomy-decortication in advanced malignant mesothelioma.

Source
European Journal of Surgical Oncology. 31(3):314-20, 2005 Apr.

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) and tumour stage (median IMIG stage 3). The biopsy only group had fewer air leaks (57, 84%) 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). Multivariate analysis showed early stage, absence of pre-operative fever and pleurectomy-decortication 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.