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

By Ed Susman - February 6, 2008

Fort Lauderdale, Florida - Stage 3 pure epithelial mesothelioma patients who underwent the more extensive treatment of radical decortication/pleurectomy in an attempt to cure the disease, appear to have significantly better results than patients who had less extensive operations, according to a study presented at the 44th Annual Meeting of the Society of Thoracic Surgeons (STS).

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

After reviewing 127 consecutive cases of patients diagnosed with stage 3 mesothelioma, however, Dr. Trousse found that the 57 patients who underwent radical decortication / pleurectomy demonstrated better overall survival at 1 year (83%) and at 2 years (73%) than patients undergoing alternative surgical treatment.

Among the 35 patients treated with extrapleural pneumonectomy, the one-year survival rate was 55% and the 2-year survival rate was 18%. 35 patients treated by vascular access thorosectomy (VATS) decortication/pleurectomy had a one-year survival rate of 67% and a 22% 2-year survival rate.

Statistical significance was reached at the P =.003 level when measuring the difference between the extensive surgery and the less extensive treatments.

The oral presentation by Dr. Trousse used data from research conducted at Glenfield Hospital, Leicester, England, United Kingdom before she relocated to Marseille, France.

Dr. Trousse said, "These data support the preferential choice of radical pleurectomy / decortication in surgical treatment for N2 positive epithelial mesothelioma."

Of note was that the 90-day survival rate in the series was best among those patients who underwent VATS pleurectomy/decortication (P =.024). VATS surgery was used for patients who were either too weak or had comorbidities that made more extensive surgical procedures undesireable.

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

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