Portal de Periódicos da CAPES

Extrapleural Pneumonectomy for Diffuse, Malignant Mesothelioma

1986; Elsevier BV; Volume: 42; Issue: 6 Linguagem: Inglês

10.1016/s0003-4975(10)64593-6

1552-6259

Michael J. DaValle, L. Penfield Faber, C. Frederick Kittle, Robert J. Jensik,

Medical Imaging and Pathology Studies

Extrapleural pneumonectomy for malignant mesothelioma is a radical procedure that entails en bloc removal of the parietal pleura, lung, pericardium, and diaphragm.Minimal tumor remains after this procedure; palliation and occasional long-term survival may be achieved in properly selected patients.Extrapleural pneumonectomy for diffuse, malignant mesothelioma was done in 33 patients (27 male and 6 female) with 18 procedures on the left side and 15 on the right.There was a history of exposure to asbestos in 16 (48%) of the patients.Histological classification revealed that 20 tumors were epithelial, 10 were mixed, and 3 were sarcomatous.Good palliation, defined as survival for 24 months with a return to fairly normal activities, was obtained in 8 patients (24%) and survival for 36 months was achieved in 5 patients.Three patients died of the disease at 59 months, 60 months, and 82 months.There were 3 operative deaths (9.1%), and serious postoperative complications occurred in 8 patients (24%).Postoperative adjunctive therapy consisting of chemotherapy or irradiation or both was given to approximately one-half of the patients.These findings indicate that extrapleural pneumonectomy for malignant mesothelioma can be done with an acceptable morbidity and mortality.Palliation is achieved in 24% of patients, and there may be an occasional longterm survivor.Malignant mesothelioma is an aggressive malignant tumor currently incurable by all forms of therapy.Chemotherapy and irradiation, alone or in combination, have not proven effective in controlling this tumor.The role of surgery in the treatment of malignant mesothelioma remains controversial, and there are those who believe that it has no place in the treatment of this disease.However, some reports indicate that a multimethod approach toward therapy may increase the length of palliation when a maximal resection of tumor is achieved (1,2].The fact that most of these patients die of the primary tumor rather than metastasis also supports aggressive local control of tumor (31.