Skip to main content
SpringerLink
Log in

Summary of Prognostic Factors and Patient Selection for Extrapleural Pneumonectomy in the Treatment of Malignant Pleural Mesothelioma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Extrapleural pneumonectomy (EPP) has been shown to improve long-term survival outcomes in selected patients with malignant pleural mesothelioma (MPM). The present study aimed to evaluate potential prognostic factors on overall survival for patients who underwent EPP for MPM and to examine the patient selection process in major referral centers that perform EPP.

Methods

A systematic review of the current literature was performed using 5 electronic databases. Relevant studies with prognostic data on overall survival for patients with MPM treated by EPP were included for review. Two reviewers independently assessed each included study.

Results

A total of 17 studies from 13 institutions containing the most updated and complete data on prognostic factors for patients with MPM who underwent EPP were included for review. A number of quantitative, clinical, and treatment-related factors were identified to have significant impact on overall survival.

Conclusions

Patients with nonepithelial MPM and nodal involvement have consistently demonstrated to have a worse prognosis after EPP. Their eligibility as candidates for EPP should be questioned. The preoperative patient selection process currently differs greatly between institutions and should focus on identifying patients with nonepithelial histologic subtypes and nodal involvement to exclude them as EPP surgical candidates in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Price B. Analysis of current trends in United States mesothelioma incidence. Am J Epidemiol. 1997;145:211–8.

    PubMed  CAS  Google Scholar 

  2. Peto J, Decarli A, La Vecchia C, Levi F, Negri E. The European mesothelioma epidemic. Br J Cancer. 1999;79:666–72.

    Article  PubMed  CAS  Google Scholar 

  3. Butchart EG, Ashcroft T, Barnsley WC, Holden MP. Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients. Thorax. 1976;31:15–24.

    Article  PubMed  CAS  Google Scholar 

  4. Treasure T, Utley M. Mesothelioma: Benefit from surgical resection is questionable. J Thorac Oncol. 2007;2:885–6.

    Article  PubMed  Google Scholar 

  5. Treasure T, Utley M. Ten traps for the unwary in surgical series: A case study in mesothelioma reports. J Thorac Cardiovasc Surg. 2007;133:1414–8.

    Article  PubMed  Google Scholar 

  6. Krug LM, Pass HI, Rusch VW, Kindler HL, Sugarbaker DJ, Rosenzweig KE, et al. Multicenter phase II trial of neoadjuvant pemetrexed plus cisplatin followed by extrapleural pneumonectomy and radiation for malignant pleural mesothelioma. J Clin Oncol. 2009;27:3007–13.

    Article  PubMed  CAS  Google Scholar 

  7. Rusch VW, Rosenzweig K, Venkatraman E, Leon L, Raben A, Harrison L, et al. A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2001;122:788–95.

    Article  PubMed  CAS  Google Scholar 

  8. Wolf AS, Richards WG, Tilleman TR, Chirieac L, Hurwitz S, Bueno R, et al. Characteristics of malignant pleural mesothelioma in women. Ann Thorac Surg. 2010;90:949–56.

    Article  PubMed  Google Scholar 

  9. Tilleman TR, Richards WG, Zellos L, Johnson BE, Jaklitsch MT, Mueller J, et al. Extrapleural pneumonectomy followed by intracavitary intraoperative hyperthermic cisplatin with pharmacologic cytoprotection for treatment of malignant pleural mesothelioma: A phase II prospective study. J Thorac Cardiovasc Surg. 2009;138:405–11.

    Article  PubMed  Google Scholar 

  10. Zellos L, Richards WG, Capalbo L, Jaklitsch MT, Chirieac LR, Johnson BE, et al. A phase I study of extrapleural pneumonectomy and intracavitary intraoperative hyperthermic cisplatin with amifostine cytoprotection for malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2009;137:453–8.

    Article  PubMed  Google Scholar 

  11. Sugarbaker DJ, Flores RM, Jaklitsch MT, Richards WG, Strauss GM, Corson JM, et al. Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg. 1999;117:54–63.

    Article  PubMed  CAS  Google Scholar 

  12. Edwards JG, Martin-Ucar AE, Stewart DJ, Waller DA. Right extrapleural pneumonectomy for malignant mesothelioma via median sternotomy or thoracotomy? Short- and long-term results. Eur J Cardiothorac Surg. 2007;31:759–64.

    Article  PubMed  Google Scholar 

  13. Rice DC, Stevens CW, Correa AM, Vaporciyan AA, Tsao A, Forster KM, et al. Outcomes after extrapleural pneumonectomy and intensity-modulated radiation therapy for malignant pleural mesothelioma. Ann Thorac Surg. 2007;84:1685–93.

    Article  PubMed  Google Scholar 

  14. De Perrot M, Feld R, Cho BCJ, Bezjak A, Anraku M, Burkes R, et al. Trimodality therapy with induction chemotherapy followed by extrapleural pneumonectomy and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma. J Clin Oncol. 2009;27:1413–8.

    Article  PubMed  Google Scholar 

  15. Weder W, Stahel RA, Bernhard J, et al. Multicenter trial of neo-adjuvant chemotherapy followed by extrapleural pneumonectomy in malignant pleural mesothelioma. Ann Oncol. 2007;18:1196–202.

    Article  PubMed  CAS  Google Scholar 

  16. Buduhan G, Menon S, Aye R, Louie B, Mehta V, Vallieres E. Trimodality therapy for malignant pleural mesothelioma. Ann Thorac Surg. 2009;88:870–5.

    Article  PubMed  Google Scholar 

  17. Pass HI, Temeck BK, Kranda K, Steinberg SM, Feuerstein IR. Preoperative tumor volume is associated with outcome in malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 1998;115:310–7.

    Article  PubMed  CAS  Google Scholar 

  18. Mineo TC, Ambrogi V, Pompeo E, Baldi A, Stella F, Aurea P, et al. The value of occult disease in resection margin and lymph node after extrapleural pneumonectomy for malignant mesothelioma. Ann Thorac Surg. 2008;85:1740–6.

    Article  PubMed  Google Scholar 

  19. Yan TD, Boyer M, Tin MM, Wong D, Kennedy C, McLean J, et al. Extrapleural pneumonectomy for malignant pleural mesothelioma: Outcomes of treatment and prognostic factors. J Thorac Cardiovasc Surg. 2009;138:619–24.

    Article  PubMed  Google Scholar 

  20. Aziz T, Jilaihawi A, Prakash D. The management of malignant pleural mesothelioma; single centre experience in 10 years. Eur J Cardiothorac Surg. 2002;22:298–305.

    Article  PubMed  Google Scholar 

  21. Trousse DS, Avaro JP, D’Journo XB, Doddoli C, Astoul P, Giudicelli R, et al. Is malignant pleural mesothelioma a surgical disease? A review of 83 consecutive extra-pleural pneumonectomies. Eur J Cardiothorac Surg. 2009;36:759–63.

    Article  PubMed  Google Scholar 

  22. Aigner C, Hoda MAR, Lang G, Taghavi S, Marta G, Klepetko W. Outcome after extrapleural pneumonectomy for malignant pleural mesothelioma. Eur J Cardiothorac Surg. 2008;34:204–7.

    Article  PubMed  Google Scholar 

  23. Travis W, Brambilla E, Muller-Hermelink H, Harris CC, eds. Pathology and genetics of tumours of the lung, pleura, thymus and heart. Lyon, France: IARC Press, 2004.

    Google Scholar 

  24. Rusch VW. A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group. Chest. 1995;108:1122–8.

    Article  PubMed  CAS  Google Scholar 

  25. Sugarbaker DJ, Strauss GM, Lynch TJ, Richards W, Mentzer SJ, Lee TH, et al. Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma. J Clin Oncol. 1993;11:1172–8.

    PubMed  CAS  Google Scholar 

  26. Scherpereel A, Astoul P, Baas P, Berghmans T, Clayson H, de Vuyst P, et al. Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J. 2010;35:479–95.

    Article  PubMed  CAS  Google Scholar 

  27. Flores RM, Pass HI, Seshan VE, Dycoco J, Zakowski M, Carbone M, et al. Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: Results in 663 patients. J Thorac Cardiovasc Surg. 2008;135:620–6.e3.

    Article  PubMed  Google Scholar 

  28. Balduyck B, Trousse D, Nakas A, Martin-Ucar AE, Edwards J, Waller DA. Therapeutic surgery for nonepithelioid malignant pleural mesothelioma: Is it really worthwhile? Ann Thorac Surg. 2010;89:907–11.

    Article  PubMed  Google Scholar 

  29. Flores RM, Routledge T, Seshan VE, Dycoco J, Zakowski M, Hirth Y, et al. The impact of lymph node station on survival in 348 patients with surgically resected malignant pleural mesothelioma: Implications for revision of the American Joint Committee on Cancer staging system. J Thorac Cardiovasc Surg. 2008;136:605–10.

    Article  PubMed  Google Scholar 

  30. Rusch VW. Indications for pneumonectomy. Extrapleural pneumonectomy. Chest Surg Clin N Am. 1999;9:327–38.

    PubMed  CAS  Google Scholar 

  31. Schouwink H, Rutgers ET, van der Sijp J, Oppelaar H, van Zandwijk N, van Veen R, et al. Intraoperative photodynamic therapy after pleuropneumonectomy in patients with malignant pleural mesothelioma: dose finding and toxicity results. Chest. 1167;120:1167–74.

    Article  Google Scholar 

  32. Treasure T. Surgery for mesothelioma: MARS landing and future missions. Eur J Cardiothorac Surg. 2010;37:509–10.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Systematic Review Group, The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia

    Christopher Cao BSc (Med), MBBS, Tristan D. Yan BSc (Med), MBBS, PhD, Paul G. Bannon MBBS, PhD, FRACS & Brian C. McCaughan MBBS, FRACS

Authors
  1. Christopher Cao BSc (Med), MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tristan D. Yan BSc (Med), MBBS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul G. Bannon MBBS, PhD, FRACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brian C. McCaughan MBBS, FRACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tristan D. Yan BSc (Med), MBBS, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cao, C., Yan, T.D., Bannon, P.G. et al. Summary of Prognostic Factors and Patient Selection for Extrapleural Pneumonectomy in the Treatment of Malignant Pleural Mesothelioma. Ann Surg Oncol 18, 2973–2979 (2011). https://doi.org/10.1245/s10434-011-1728-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-011-1728-x

Keywords

Search

Navigation