Original articleGeneral thoracicExtended Surgical Staging for Potentially Resectable Malignant Pleural Mesothelioma
Section snippets
Patients and Methods
Between October 1999 and June 2004, 383 patients with MPM were evaluated at the University of Texas M.D. Anderson Cancer Center. A retrospective review was performed on 118 consecutive patients with histologically confirmed MPM who were considered to have potentially resectable MPM after undergoing extensive diagnostic imaging and physiologic screening. The study was approved by the M.D. Anderson Cancer Center Institutional Review Board. Routine diagnostic imaging included contrast enhanced CT
Results
One hundred eighteen patients were considered candidates for extrapleural pneumonectomy and underwent ESS. Patient characteristics are presented in Table 1. Laparoscopy was performed in 109 patients. Nine (8.3%) patients had transdiaphragmatic extension of tumor, and 1 (0.9%) patient had diffuse peritoneal metastases. A review of axial CT images (n = 4) and CT images reconstructed in coronal, sagittal, and axial planes when integrated CT–positron emission tomography imaging was performed (n =
Comment
Results of this study show that ESS procedures improve the accuracy of MPM staging, and are important in determining appropriate therapy in patients being considered for extrapleural pneumonectomy. Specifically, extrapleural pneumonectomy was precluded because of positive findings at ESS in 15 of the 118 patients (12.7%). In this regard, laparoscopy was particularly useful in detecting unsuspected transdiaphragmatic extension of tumor. Although laparoscopy has been shown to improve staging
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