Aigner Clemens, Hoda Mir Ali Reza, Lang Gyoergy, Taghavi Shahrokh, Marta Gabriel, Klepetko Walter
Department of Cardio-Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Eur J Cardiothorac Surg. 2008 Jul;34(1):204-7. doi: 10.1016/j.ejcts.2008.03.003. Epub 2008 Apr 14.
Malignant pleural mesothelioma is a mainly asbestos-related neoplasm that occurs with increasing frequency and is associated with a poor prognosis. Extrapleural pneumonectomy which was initially performed as a stand-alone treatment in patients with resectable disease is now currently almost uniformly applied as part of a multi-modal approach. Its value and advantage over other therapeutic strategies remain points of discussion. We therefore analysed our experience with extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma.
We retrospectively reviewed our institutional experience with all consecutive patients undergoing extrapleural pneumonectomy for malignant pleural mesothelioma from 1994 to 2005. Patients were analysed with regard to hospital mortality and morbidity and long-term outcome.
Forty-nine patients (10 female/39 male, mean age 58+12 years) underwent extrapleural pneumonectomy during the observation period. Median ICU stay was 1 day, median postoperative length of hospital stay was 13 days. After a mean follow-up of 2573 days, median survival was 376 days (mean 672+121 days, range 9-3384). One-year survival was 53%, 3-year survival 27% and 5-year survival 19%.
Extrapleural pneumonectomy as part of a multi-modality treatment regimen is a good treatment option for selected patients with malignant pleural mesothelioma. The long-term results of this limited series compare favourably to non-surgical treatment regimens. Larger randomised prospective multi-centre trials are warranted to establish clear guidelines.
恶性胸膜间皮瘤是一种主要与石棉相关的肿瘤，其发病率呈上升趋势，且预后较差。胸膜外全肺切除术最初是作为可切除疾病患者的单一治疗方法，现在几乎都作为多模式治疗方法的一部分应用。其相对于其他治疗策略的价值和优势仍是讨论的焦点。因此，我们分析了我们在胸膜外全肺切除术治疗恶性胸膜间皮瘤方面的经验。
我们回顾性分析了1994年至2005年期间在我院接受胸膜外全肺切除术治疗恶性胸膜间皮瘤的所有连续患者的经验。对患者的医院死亡率、发病率和长期结局进行了分析。
在观察期内，49例患者（10例女性/39例男性，平均年龄58±12岁）接受了胸膜外全肺切除术。重症监护病房（ICU）中位住院时间为1天，术后中位住院时间为13天。平均随访2573天后，中位生存期为376天（平均672±121天，范围9 - 3384天）。1年生存率为53%，3年生存率为27%，5年生存率为19%。
胸膜外全肺切除术作为多模式治疗方案的一部分，对于部分选定的恶性胸膜间皮瘤患者是一种较好的治疗选择。这个有限系列的长期结果与非手术治疗方案相比具有优势。有必要进行更大规模的随机前瞻性多中心试验以建立明确的指南。
