Mesothelioma and Histological Evidence of Extra Pleural Lymph Node Metastases

Mesothelioma and Histological Evidence of Extra Pleural Lymph Node Metastases

Another interesting study is called, "The case for routine cervical mediastinoscopy prior to radical surgery for malignant pleural Mesothelioma" by J.E. Pillinga, D.J. Stewarta, A.E. Martin-Ucara, S. Mullerb, K.J. O'Byrnec, D.A. Wallera - Eur J Cardiothorac Surg 2004;25:497-501. Here is an excerpt: "Objectives: To assess whether cervical mediastinoscopy is necessary before radical resection of malignant pleural mesothelioma (MPM). Methods: Patients who underwent radical excision of MPM in a 48-month period were prospectively followed for evidence of disease recurrence and death. Histological evidence of extra pleural lymph node metastases was correlated with survival. Lymph node size at intraoperative lymphadenectomy was correlated with the presence of metastatic tumour. Results: The 55 patients who underwent radical resection (51 extra pleural pneumonectomies and 4 radical pleurectomies) comprised 50 men and 5 women with a median age of 58 years, range 4170. Histological examination revealed 50 epithelioid, four biphasic and one sarcomatoid histology. Postoperative IMIG T stage was stage I 4, II 11, III 30 and IV 10. Postoperatively the 17 patients with metastases to the extra pleural lymph nodes had significantly shorter survival (median 4.4 months, 95% CI 3.25.4) than those without (median survival 16.3 months, 95% CI 11.621.0) P=0.012 KaplanMeier analysis. Seventy-seven extra pleural lymph nodes without metastases were measured with a mean long axis diameter of 16.9 mm (range 455); 22 positive nodes had a mean long axis diameter of 15.2 mm (range 630). In 15 of the 17 patients with positive extra pleural nodes, the nodes could have been biopsied at cervical mediastinoscopy. Conclusions: This study confirms that extra pleural nodal metastases are related to poor survival. Pathological nodal involvement cannot be predicted from nodal dimensions. These data suggest that all patients being considered for radical resection of MPM should preferentially undergo preoperative cervical mediastinoscopy irrespective of radiological findings."

Another interesting study is called, "Induction chemotherapy, extrapleural pneumonectomy, and radiotherapy in the treatment of malignant pleural mesothelioma: The Memorial Sloan-Kettering experience" - Volume 49, Supplement 1, Pages S71-S74 (July 2005) by Raja M. Flores. Here is an excerpt: "Summary - Approximately 25% of patients with malignant pleural mesothelioma (MPM) prove unresectable at surgery and the median survival of stage III MPM is

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