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EPP and P/D: which to choose?

Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan

Radical surgery for malignant pleural mesothelioma: results and prognosis

I read with great interest the article by Okada and others [1]. I believe that this article represents the state of the art of surgical treatment for malignant plural mesothelioma (MPM) in Japan, not only because this is Japan's largest series famous for close collaboration of MPM experts.

In the present study, there was no significant difference of survival between extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). Okada interprets that the result reflects relatively early stage disease and predominant epithelial histology in P/D group. However, a similar result has been reported from Memorial Sloan-Kettering Cancer Center Group [2], where more than half of the patients were belonging to unclassified histology and staging information was missing in almost half of the patients. The above facts lead to a hypothesis that EPP and P/D might be equal in view of postoperative median survival. The possible mechanism is that severity of EPP may offset its curative power. If so, EPP should be indicated only for patients who seek for cure, not for extending survival with MPM.

It is still unsolved whether P/D is just a limited surgery for patients with poor surgical durability or not. I am interested in the authors' current policy for P/D.

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1. Okada M, Mimura T, Ohbayashi C, Sakuma T, Soejima T, Tsubota N. Radical surgery for malignant pleural mesothelioma: results and prognosis. Interact CardioVasc Thorac Surg 2008; 7:102–106.[Abstract/Free Full Text]
2. Flores RM, Zakowski M, Venkatraman E, Krug L, Rosenzweig K, Dycoco J, Lee C, Yeoh C, Bains M, Rusch V. Prognostic factors in the treatment of malignant pleural mesothelioma at a large tertiary referral center. J Thorac Oncol 2007; 2:957–965.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Seiki Hasegawa Permission Requests Google Scholar Articles by Hasegawa, S. PubMed Articles by Hasegawa, S. Related Collections Related Article