To evaluate the effectiveness of extrapleural pneumonectomy (EPP), its tolerability and its impact on survival with the adjuvant therapy.
Thirty-one EPP submitted patients (20 female, 11 male, range age of 31-70 years) were observed between 1994 and 2003. Selection criteria were: performance status 0-1, clinical stage I, epithelial histology, predictive postoperative FEV1>1.0 L and resectable lung perfusion less or equal to 50%, room air PaO2>65 mmHg, PaCO2<45 mmHg, ejection fraction >40%. TC and/or MR so PET scan were employed. Videothoracoscopy for diagnosis and for pleurodesis was made in all the cases. Twenty right EPPs and 11 left ones were observed. Seventeen cases had only 7th intercostal space approach. Most pericardial (96.7%) and diaphragmatic (49%) defects were repaired by PTFE. Twenty-seven were epithelioids, 1 sarcomatous and 3 biphasics. We have observed until July 2002 16 stages III according to Brigham staging system and only 6 stages I, but to October 2003 further 9 stages I. In the 2nd period more attention and strict criteria were taken.
Four re-thoracotomies were for hemostasis, 2 bronchial stump fistulae, 1 superior vena cava thrombosis and 1 thoracoplastic dehiscence. Twenty-five patients received adjuvant radiotherapy: 11 only over the videothoracoscopy accesses, 3 simple over the operated side, the remaining 11 with chemotherapy. These last patients completed the trimodality treatment as Sugarbaker suggestions. One patient had only chemotherapy. Eleven deaths for disease were at the end of follow-up, 1 death for brain stroke, 3 alives with recurrence, 1 with a new tumor (GI), 15 without other disease. The percentage of survival calculated by Kaplan-Meier methods in stage I disease was 73.8% after 5 years and, in stage III fall down to 26.8% at the same period.
Good patient selection, prevention of complications, attention and standardization of operative procedure reduce hospitalizations and improve quality of life.
The ideal treatment for MPM doesn’t exist. Histotype, stage and trimodality therapy may prolong survival.
C. Lequaglie, None.