Extrapleural Pneumonectomy in the Treatment of Epithelial Malignant Pleural Mesothelioma: Experience in 529 Patients
David Sugarbaker, William Richards*, Raphael Bueno
Brigham and Women's Hospital, Boston, MA
OBJECTIVE(S): We reviewed our experience over a 24-year period with extrapleural pneumonectomy (EPP) in the treatment of epithelial malignant pleural mesothelioma (MPM).
METHODS: Retrospective review of an IRB-approved prospective patient database, using descriptive statistics and Kaplan-Meier analysis of overall survival.
RESULTS: From 1988-2011, 529 patients with epithelial MPM underwent complete resection by EPP as part of a multimodality strategy. Among these, 131 (25%) were women, and the median age was 59 (range 17-79) years. Median postoperative hospital stay was 10 (1-101) days. Twenty-nine patients (5.4%) experienced 30 day or in-hospital mortality. Median overall survival was 18 months, with 1, 3, 5 and 10-year survival rates of 67%, 28%, 14% and 4%, respectively. Outcome by pathologic lymph node status (N, median OS) was N0: 224, 26 months; N1: 118, 17 months; N2: 181, 13 months; N3: 5, 7 months; Nx: 1, N/A.
CONCLUSIONS: 1) EPP has evolved as an effective method of achieving macroscopic complete resection; 2) These data further establish node status as a significant predictor of OS in epithelial MPM; 3) The routine use of mediastinoscopy and/or EBUS will allow for more effective selection of patients who will benefit from cytoreduction by EPP; and 4) Future studies should focus on further refining preoperative patient selection and enhancing local control.
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