Pleurectomy for Mesothelioma

Med J Aust. 1991 Apr 1;154(7):455-7, 460.

Abstract

Objective: To assess the effectiveness and safety of parietal pleurectomy in establishing a tissue diagnosis and controlling pleural fluid accumulation in patients with pleural mesothelioma, and to assess the success of this procedure in effecting palliation.

Design and setting: Fifty consecutive patients with pleural mesothelioma who underwent thoracotomy at the cardiothoracic units at Concord and Royal Prince Alfred Hospital were reviewed retrospectively. The male:female ratio was 4:1 and the mean age was 63 years. In only 11 of the 50 patients was a tissue diagnosis of mesothelioma made before surgery.

Interventions: At thoracotomy, subtotal parietal pleurectomy was performed in 45 of the 50 patients. In two patients biopsy alone was performed and three patients were treated by a chemical pleurodesis only, as pleurectomy was not technically possible. Pulmonary decortication was required in 28 patients to allow full expansion of the underlying lung for effective pleurodesis.

Results: There was one postoperative death. The morbidity rate was 16%. Excluding the patient who died in the postoperative period, the median survival was 16 months, and ranged from three to 54 months, with 21% of patients surviving for more than two years. Only one patient developed a reaccumulation of pleural fluid.

Conclusions: Pleurectomy, with decortication when required, provides both a tissue diagnosis and effective control of pleural fluid accumulation and therefore excellent palliation in patients with pleural mesothelioma. We advocate early thoracotomy in these patients.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Evaluation Studies as Topic
  • Female
  • Humans
  • Male
  • Mesothelioma / complications
  • Mesothelioma / mortality
  • Mesothelioma / pathology
  • Mesothelioma / surgery*
  • Middle Aged
  • Palliative Care / methods
  • Pleura / surgery*
  • Pleural Effusion / etiology
  • Pleural Effusion / mortality
  • Pleural Effusion / surgery
  • Pleural Neoplasms / complications
  • Pleural Neoplasms / mortality
  • Pleural Neoplasms / pathology
  • Pleural Neoplasms / surgery*
  • Prognosis
  • Reoperation
  • Retrospective Studies
  • Thoracotomy / methods
  • Thoracotomy / mortality