The Annals of Thoracic Surgery, Vol 31, 53-60, Copyright © 1981 by The Society of Thoracic Surgeons
Diffuse, mixed malignant pleural mesothelioma
RJ Lewis, GE Sisler and JW Mackenzie
Forty-six patients with diffuse, mixed malignant pleural mesothelioma were
treated between January, 1970, and May, 1979. All had a history of exposure
to asbestos. The diagnosis was established by thoracentesis in 3 patients,
thoracoscopy in 28, thoracotomy in 5, and minithoracotomy in 9.
Mediastinoscopy was performed in 31 patients and bronchoscopy in 32.
Mediastinoscopy was positive in only 1 patient, and in no patient was
bronchoscopy positive. Ten patients received no definitive therapy and
survived an average of 9.1 months (1 lived for 16 months). Thirty- one
patients received chemotherapy and survived an average of 9.6 months, the 2
longest survivors each lived for 24 months. Five patients appeared to have
early disease and therefore underwent thoracotomy. In only 2 of these
patients did resection of all gross disease appear possible. One patient
with incomplete removal is still alive after 9 months. The other 4 are all
dead, having survived an average of only 6.75 months. We believe that
pleural mesothelioma should be considered an unresectable neoplasm because
of its multicentric origin and its diffusely invasive nature, and that
attempts at partial or complete resection are not indicated. Until
prospective, controlled studies demonstrate otherwise, patients with
diffuse, mixed malignant mesothelioma should have the most benign surgical
procedure necessary to establish a diagnosis.
