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Radical Decortication/Pleurectomy Best Surgical Approach for N2 Malignant Mesothelioma: Presented at STS

By Ed Susman

FORT LAUDERDALE, FL -- February 1, 2008 -- Patients who underwent the more extensive treatment of radical decortication/pleurectomy in attempt to cure stage 3 pure epithelial mesothelioma appear to have significantly better outcomes than patients who had less extensive operations, according to a study presented here at the Society of Thoracic Surgeons 44th Annual Meeting (STS).

"There is no gold standard surgical procedure in stage 3 mesothelioma," said Delphine Trousse, MD, Registrar in Thoracic Surgery, Hôpital Sainte Marguerite, Marseille, France, in a presentation on January 29.

However, in reviewing 127 consecutive cases of patients who presented with stage 3 mesothelioma, Dr. Trousse found that the 57 patients who underwent radical decortication/pleurectomy had better overall survival at 1 year (83%) and at 2 years (73%) than did patients treated with alternative surgical techniques.

One-year survival among the 35 patients treated by extrapleural pneumonectomy was 55% and 2-year survival was 18%. One-year survival for 35 patients who were treated by vascular access thorosectomy (VATS) decortication/pleurectomy was 67% and 2-year survival was 22%.

The difference between the extensive surgery and the less extensive treatments reached statistical significance at the P =.003 level.

Dr. Trousse's oral presentation reported used data from Glenfield Hospital, Leicester, England, United Kingdom, where she conducted her research before relocating to Marseille, France.

"These data support the preferential choice of radical pleurectomy/decortication in surgery for N2 positive epithelial mesothelioma," she said.

She noted that 90-day survival in the series was best among patients who underwent VATS pleurectomy/decortication (P =.024). VATS surgery was reserved for patients who were either too frail or had comorbidities that made them unfit for the more extensive surgical procedures.

"Long-term survival was not associated with sex, age," she said. There were 104 men and 23 women in the series; the average age of the patients undergoing surgery was 62 years.

"Median survival for the whole group was 50 months, with 1-year survival of 63%, 38% at 2 years and 14% at 3 years, which is pretty good survival for stage 3 mesothelioma," Dr. Trousse said.


[Presentation title: Which is the Best Surgical Approach for N2 Positive Epithelial Malignant Mesothelioma? Long-Term Outcome After Extrapleural Pneumonectomy Versus Radical and VATS Decortication/Pleurectomy. Abstract 42]

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