Morbidity and mortality, sites of recurrence, and possible prognostic factors in 95 (78 male, 17 female) patients with MPM on phase I-III trials since 1990 were analyzed. A debulking resection (excision) to a requisite, residual tumor thickness of at least 5 mm was required for inclusion in the study. METHODS: Preoperative tumor volumes were determined by three-dimensional reconstruction of chest computerized tomograms. Pleurectomy or extrapleural pneumonectomy (EPP) was performed. Seventeen patients could not be debulked. Preoperative EPP platelet counts (404,000) and mean tumor volume (491 cubic centimeters) were greater than that seen for pleurectomy (344,000, 114 cubic centimeters). RESULTS: Median survival for all patients was 11.2 months, with that for pleurectomy 14.5 months, that for EPP 9.4 months, and that for unresectable patients 5.0 months. Arrhythmia (15%) was the most common complication, and there were two deaths related to surgery (2%).
Tumor volume of greater than 100 milliliter, biphasic histology, male sex, and elevated platelet count were associated with decreased survival. Both EPP and pleurectomy had equivalent recurrence rates (27 of 39 [69%] and 31 of 39 [79%], respectively); however, 17 of 27 EPP recurrences as opposed to 28 of 31 pleurectomy recurrences were locoregional (to the original tumor site). CONCLUSIONS: Debulking resections for MPM can be performed with low operative mortality. Size and platelet count are important preoperative prognostic parameters for MPM. Patients with poor prognostic indicators should probably enter nonsurgical, innovative trials where toxicity or response to therapy can be evaluated. Pass, et al., Annals of Surgical Oncology, 4(3):215-22, April through May 1997.
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