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Marc de Perrot
Masaki Anraku
Gail Darling
Thomas K. Waddell
Andrew F. Pierre
Shaf Keshavjee
Michael R. Johnston
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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

Marc de Perrot, MD*, Karl Uy, MD, Masaki Anraku, MD, Ming S. Tsao, MD, Gail Darling, MD, Thomas K. Waddell, MD, Andrew F. Pierre, MD, Andrea Bezjak, MD, Shaf Keshavjee, MD, Michael R. Johnston, MD

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.

Abbreviations and Acronyms CT = computed tomography; MPM = malignant pleural mesothelioma




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