We compared less invasive surgery with conventional surgery for malignant pleural
mesothelioma (MPM). We retrospectively reviewed consecutive patients with MPM who
received surgery at Hyogo College of Medicine between July 2004 and April 2016. Patients
underwent multimodal treatment comprising chemotherapy (neoadjuvant and/or adjuvant)
and surgery with or without 54 Gy hemithoracic radiotherapy. Patients were grouped
into 3 groups according to the surgery intended: Conventional extrapleural pneumonectomy
was intended in Group 1 (until August 2009); less invasive extrapleural pneumonectomy
was intended in Group 2 (after September 2009); pleurectomy/decortication was intended
in Group 3 (after September 2012). We included 152 patients (median age 64 [37–71]
years; 131 men, 21 women), mostly with epithelioid subtypes (91.4%). Of them, 149
(98.0%) underwent neoadjuvant chemotherapy and 117 (77.0%) underwent surgery (60 had
extrapleural pneumonectomy and 57 had pleurectomy/decortication). Macroscopic complete
resection was achieved in 94.9% (111/117), and the mortality rates at 30 and 90 days
were 1.7% (2/117) and 3.4% (4/117), respectively. The overall median survival time
and progression-free survival for all 152 patients were 34.9 and 17.4 months. The
overall median survival time for Groups 1, 2, and 3 were 18.5, 41.9, and 43.4 months,
respectively. The progression-free survival for Groups 1, 2, and 3 were 12.0, 24.5,
and 21.8 months, respectively. Compared with conventional surgical techniques, less
invasive surgery for MPM yielded lower surgical risks and comparable or improved survival.
Keywords
Abbreviations:
CT (computed tomography), EPP (extrapleural pneumonectomy), FDG-PET (18F-fluorodeoxyglucose positron emission tomography), MPM (malignant pleural mesothelioma), MST (median survival time), P/D (pleurectomy/decortication), PFS (progression-free survival)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 10, 2019
Footnotes
Conflicts of Interest and Sources of Funding: Seiki Hasegawa received research fund from Elli Lilly and Company, Taiho Pharmaceuticals, and Ono Pharmaceuticals. The remaining authors have declared no conflicts of interest. This work was supported partly by the Special Coordination Funds for Promoting Science and Technology from the Japanese Ministry of Education, Culture, Sports, Science and Technology and partly by programs for promoting clinical cancer research through a Japanese Health and Labor Sciences Research Grant.
Notification of Prior Abstract Publication/Presentation: Part of this study was presented at several annual meetings of the International Mesothelioma Interest Group (September 3, 2010, Kyoto, Japan; September 12, 2012, Boston, USA; October 21, 2014, Cape Town, South Africa; May 3, 2016, Birmingham, UK) and at the 21st European Conference on General Thoracic Surgery (May 27, 2013, Birmingham, UK).
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- Can Maximally Invasive Surgery Be Minimized?Seminars in Thoracic and Cardiovascular SurgeryVol. 31Issue 2
- PreviewPatients with malignant pleural mesothelioma (MPM) have a maximally invasive disease that requires intensive therapy to improve outcomes. Dr Hasegawa et al should be commended for presenting a large series of patients with excellent outcomes and reporting the evolution of their surgical approach over 12 years. While they present a “less invasive surgery” for MPM, the “less” is relative to one of the most invasive operations in thoracic surgery. Even in their experienced hands, the operation remains major undertaking.
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