O-138are We Over-extended in the Surgical Treatment of Mesothelioma? the Tale of the Unnecessary Phrenectomy
Year: 2015
Type: conference-abstract
Abstract: Objectives: Macroscopic complete resection with lung preservation is the objective of radical management of pleural mesothelioma (MPM). Total removal of visceral and parietal pleura (pleurectomy/decortication) almost invariably proceeds to an extended pleurectomy/decortication (EPD) to ensure macroscopic complete resection MCR. We suspected this may not always be necessary. Methods: We reviewed 314 patients, 85.9% male, median age 62 years (range 14-81) undergoing radical surgery for MPM from 1999-2014, by either EPD or extrapleural pneumonectomy. The extent of diaphragmatic muscle involvement was recorded from postoperative pathology. Patients were divided into 3 groups; no involvement, non-transmural, and transmural diaphragmatic invasion. Results: Two hundred and thirteen (68%) patients underwent EPD, 235 (75%) had epithelioid disease and 57% were node positive. In 119 patients (38%) there was no involvement of the diaphragm. There was no difference between the 3 groups in terms of age, cell type, laterality, neo-adjuvant chemotherapy and operation. There was a higher degree of diaphragm involvement in females (P = 0.004), and in patients with positive lymph nodes (P = 0.005). The incidence of abdominal disease progression was 10.2%. There was no correlation with degree of diaphragmatic invasion ρ = 0.049, P = 0.547. Overall survival of those with abdominal progression was similar to those with progression elsewhere: 13.0 months vs 16.1 months (P = 0.791), and with those with no progression (16.0 months, P = 0.422). There was no difference in survival when stratified by diaphragmatic involvement P = 0.997. Conclusions: In our cohort, there was no evidence of diaphragmatic invasion in over 30% of patients. It may be therefore unnecessary to resect the diaphragm in all cases, and a pleurectomy-decortication may suffice. However, there is an unknown risk of R2 resection which would prejudice survival. Nevertheless, we have failed to find evidence that peritoneal disease progression affects overall survival following radical management. This may allay the fear of ‘unnecessary’ phrenectomy. Disclosure: No significant relationships.
Authors: Annabel Sharkey, A. Nakas, S. Tenconi, D. Waller
Institution: Glenfield Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2587785395