Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
J Thorac Cardiovasc Surg. 2023 May;165(5):1722-1730. doi: 10.1016/j.jtcvs.2022.11.035. Epub 2022 Dec 14.
Mesothelioma is a nearly uniformly fatal tumor. Multimodality therapy including cytoreductive surgery and chemotherapy is associated with long-term survival in some patients. Cytoreductive surgery for thoracic disease includes a lung-sparing operation called an "extended pleurectomy/decortication" or a lung-sacrificing surgery called an "extrapleural pneumonectomy." The benefit of cytoreductive surgery for bicavitary disease (chest and abdomen) is poorly understood. Our objective was to evaluate the long-term survivals for patients undergoing cytoreductive surgery for bicavitary disease and to determine whether any prognostic factors were associated with outcome.
We reviewed our Institutional Review Board-approved, institutional, International Association for the Study of Lung Cancer Mesothelioma Staging Project database. Inclusion criteria were all patients who underwent cytoreductive surgery for bicavitary disease. Overall survival was calculated by Kaplan-Meier methodology. All International Association for the Study of Lung Cancer database elements were evaluated by univariable analysis.
From February 2014 to August 2021, 440 patients with mesothelioma were evaluated. Fourteen patients (3%) underwent cytoreductive surgery of both chest and abdomen as a planned 2-stage operation. Most patients (13/14; 93%) underwent chest surgery before abdomen surgery. For the entire cohort, the median overall survival was 33.6 months with a 5-year survival of 20%. Extended pleurectomy/decortication was associated with a better outcome compared with extrapleural pneumonectomy, with median overall survivals of 58.2 versus 13.5 months, respectively.
For a highly selected group of patients with bicavitary mesothelioma, long-term survival can be achieved with an aggressive, staged surgical approach. The patients who undergo extended pleurectomy/decortication with preservation of the lung appear to have more favorable outcomes compared with patients undergoing extrapleural pneumonectomy.
间皮瘤几乎是一种致命的肿瘤。包括细胞减灭术和化疗在内的多模式治疗在某些患者中与长期生存相关。胸部疾病的细胞减灭术包括一种称为“扩展胸膜切除术/剥脱术”的肺保留手术，或一种称为“胸膜外全肺切除术”的肺牺牲手术。细胞减灭术治疗双腔疾病（胸部和腹部）的益处尚未得到充分理解。我们的目的是评估接受双腔疾病细胞减灭术的患者的长期生存率，并确定是否有任何预后因素与结果相关。
我们回顾了我们机构审查委员会批准的机构、国际肺癌协会间皮瘤分期项目数据库。纳入标准是所有接受双腔疾病细胞减灭术的患者。采用 Kaplan-Meier 方法计算总生存率。通过单变量分析评估所有国际肺癌协会数据库元素。
从 2014 年 2 月至 2021 年 8 月，对 440 名间皮瘤患者进行了评估。14 名患者（3%）接受了胸部和腹部的细胞减灭术作为计划中的 2 期手术。大多数患者（13/14；93%）先进行胸部手术，然后再进行腹部手术。对于整个队列，中位总生存期为 33.6 个月，5 年生存率为 20%。与胸膜外全肺切除术相比，扩展胸膜切除术/剥脱术的结局更好，中位总生存期分别为 58.2 个月和 13.5 个月。
对于一组高度选择的双腔间皮瘤患者，采用积极的分期手术方法可以实现长期生存。与接受胸膜外全肺切除术的患者相比，接受保留肺的扩展胸膜切除术/剥脱术的患者似乎有更好的结果。
