SURGICALLY DEBULKED MALIGNANT PLEURAL MESOTHELIOMA - RESULTS AND PROGNOSTIC FACTORS

Background: We analyzed morbidity and mortality, sites of recurrence, and possible prognostic factors in 95 (78 male, 17 female) patients wi th MPM on phase I-III trials since 1990. A debulking resection to a re quisite, residual tumor thickness of less than or equal to 5 mm was re quired for inclusion. Methods: Preoperative tumor volumes were determi ned by three-dimensional reconstruction of chest computerized tomogram s. Pleurectomy (n = 39) or extrapleural pneumonectomy (EPP; n = 39) wa s performed. Seventeen patients could not be debulked. Preoperative EP P platelet counts (404,000) and mean tumor volume (491 cm(3)) were gre ater than that seen for pleurectomy (344,000, 114 cm(3)). Results: Med ian survival for all patients was 11.2 months, with that for pleurecto my 14.5 months, that for EPP 9.4 months, and that for unresectable pat ients 5.0 months. Arrhythmia (n = 14; 15%) was the most common complic ation, and there were two deaths related to surgery (2.0%). Tumor volu me of >100 ml, biphasic histology, male sex, and elevated platelet cou nt were associated with decreased survival (p < 0.05). Both EPP and pl eurectomy 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 (p(2) = 0.013). Co nclusions: Debulking resections for MPM can be performed with low oper ative mortality. Size and platelet count are important preoperative pr ognostic parameters for MPM. Patients with poor prognostic indicators should probably enter nonsurgical, innovative trials where toxicity or response to therapy can be evaluated.