HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marc de Perrot Masaki Anraku Gail Darling Thomas K. Waddell Andrew F. Pierre Shaf Keshavjee Michael R. Johnston Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by de Perrot, M. Articles by Johnston, M. R. Search for Related Content PubMed PubMed Citation Articles by de Perrot, M. Articles by Johnston, M. R.

J Thorac Cardiovasc Surg 2007;133:111-116
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Impact of lymph node metastasis on outcome after extrapleural pneumonectomy for malignant pleural mesothelioma

Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Canada.

Received for publication March 22, 2006; revisions received April 29, 2006; accepted for publication June 7, 2006.

^_* Address for reprints: Marc de Perrot, MD, Division of Thoracic Surgery, Toronto General Hospital, 200 Elizabeth St, Toronto, M5G 2C4 Ontario. (Email: marc.deperrot{at}uhn.on.ca).

OBJECTIVES: Extrapleural pneumonectomy is a therapeutic option for selected patients with malignant pleural mesothelioma. The impact of lymph node metastasis on the site of recurrence and the role of mediastinoscopy in the selection of patients for extrapleural pneumonectomy, however, remain unclear.

METHODS: We reviewed 50 consecutive patients undergoing extrapleural pneumonectomy for malignant pleural mesothelioma in our institution between January 1993 and March 2005.

RESULTS: The median survival was 11 months, with a 3-year survival of 24%. Survival was significantly worse for patients with N2 disease than for those with no lymph node metastasis (median survival 10 months vs 29 months, respectively, P = .005). Patient sex, histologic cell type, stage, and N2 disease, but not mediastinoscopy, had significant impacts on survival according to univariate analysis. In a multivariate analysis, however, only the presence of N2 disease remained a significant predictor of poor outcome. The proportion of patients with N2 disease and the long-term survival was similar regardless of whether preoperative mediastinoscopy yielded a negative result. The initial site of recurrence was determined in 28 patients (locoregional in 10 and distant in 18). The presence of N2 disease had no impact on the site of recurrence. Adjuvant hemithoracic radiation therapy, however, significantly decreased the risk of locoregional recurrence.

CONCLUSIONS: The presence of N2 disease negatively affects the prognosis of patients with malignant pleural mesothelioma. Mediastinoscopy, however, seems to have a limited role in patient selection for extrapleural pneumonectomy. Adjuvant hemithoracic radiation therapy but not N2 disease affects the risk of locoregional recurrence.

This article has been cited by other articles:

				D. C. Rice, M. A. Steliga, J. Stewart, G. Eapen, C. A. Jimenez, J. H. Lee, W. L. Hofstetter, E. M. Marom, R. J. Mehran, A. A. Vaporciyan, et al. Endoscopic ultrasound-guided fine needle aspiration for staging of malignant pleural mesothelioma. Ann. Thorac. Surg., September 1, 2009; 88(3): 862 - 868. [Abstract] [Full Text] [PDF]

				T. D. Yan, M. Boyer, M. M. Tin, D. Wong, C. Kennedy, J. McLean, P. G. Bannon, and B. C. McCaughan Extrapleural pneumonectomy for malignant pleural mesothelioma: outcomes of treatment and prognostic factors. J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 619 - 624. [Abstract] [Full Text] [PDF]

				L. M. Krug, H. I. Pass, V. W. Rusch, H. L. Kindler, D. J. Sugarbaker, K. E. Rosenzweig, R. Flores, J. S. Friedberg, K. Pisters, M. Monberg, et al. Multicenter Phase II Trial of Neoadjuvant Pemetrexed Plus Cisplatin Followed by Extrapleural Pneumonectomy and Radiation for Malignant Pleural Mesothelioma J. Clin. Oncol., June 20, 2009; 27(18): 3007 - 3013. [Abstract] [Full Text] [PDF]

				M. de Perrot, R. Feld, B.C. J. Cho, A. Bezjak, M. Anraku, R. Burkes, H. Roberts, M. S. Tsao, N. Leighl, S. Keshavjee, et al. Trimodality Therapy With Induction Chemotherapy Followed by Extrapleural Pneumonectomy and Adjuvant High-Dose Hemithoracic Radiation for Malignant Pleural Mesothelioma J. Clin. Oncol., March 20, 2009; 27(9): 1413 - 1418. [Abstract] [Full Text] [PDF]

				A. Nakas, D. S. Trousse, A. E. Martin-Ucar, and D. A. Waller Open lung-sparing surgery for malignant pleural mesothelioma: the benefits of a radical approach within multimodality therapy Eur. J. Cardiothorac. Surg., October 1, 2008; 34(4): 886 - 891. [Abstract] [Full Text] [PDF]

				K. G. Tournoy, S. A. Burgers, J. T. Annema, F. Vermassen, M. Praet, M. Smits, H. M. Klomp, J. P. van Meerbeeck, and P. Baas Transesophageal Endoscopic Ultrasound with Fine Needle Aspiration in the Preoperative Staging of Malignant Pleural Mesothelioma Clin. Cancer Res., October 1, 2008; 14(19): 6259 - 6263. [Abstract] [Full Text] [PDF]

				R. M. Flores, T. Routledge, V. E. Seshan, J. Dycoco, M. Zakowski, Y. Hirth, and V. W. Rusch The impact of lymph node station on survival in 348 patients with surgically resected malignant pleural mesothelioma: Implications for revision of the American Joint Committee on Cancer staging system J. Thorac. Cardiovasc. Surg., September 1, 2008; 136(3): 605 - 610. [Abstract] [Full Text] [PDF]

				A. R. M. Abdel Rahman, R. M. Gaafar, H. A. Baki, H. M. El Hosieny, F. Aboulkasem, E. G. Farahat, A. M. Nouh, and K. A. Mansour Prevalence and Pattern of Lymph Node Metastasis in Malignant Pleural Mesothelioma Ann. Thorac. Surg., August 1, 2008; 86(2): 391 - 395. [Abstract] [Full Text] [PDF]

				M. J. Liptay Invited Commentary Ann. Thorac. Surg., August 1, 2008; 86(2): 395 - 395. [Full Text] [PDF]

				C. Aigner, M. A. R. Hoda, G. Lang, S. Taghavi, G. Marta, and W. Klepetko Outcome after extrapleural pneumonectomy for malignant pleural mesothelioma. Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 204 - 207. [Abstract] [Full Text] [PDF]

				T. C. Mineo, V. Ambrogi, E. Pompeo, A. Baldi, F. Stella, P. Aurea, and M. Marino The Value of Occult Disease in Resection Margin and Lymph Node After Extrapleural Pneumonectomy for Malignant Mesothelioma Ann. Thorac. Surg., May 1, 2008; 85(5): 1740 - 1746. [Abstract] [Full Text] [PDF]

				M. Anraku, K. S. Cunningham, Z. Yun, M.-S. Tsao, L. Zhang, S. Keshavjee, M. R. Johnston, and M. de Perrot Impact of tumor-infiltrating T cells on survival in patients with malignant pleural mesothelioma. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 823 - 829. [Abstract] [Full Text] [PDF]

				M. de Perrot, K. McRae, M. Anraku, K. Karkouti, T. K. Waddell, A. F. Pierre, G. Darling, S. Keshavjee, and M. R. Johnston Risk Factors for Major Complications After Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma Ann. Thorac. Surg., April 1, 2008; 85(4): 1206 - 1210. [Abstract] [Full Text] [PDF]