Multimodality Therapy for Malignant Pleural Mesothelioma: ResultsMedian length of hospital stay following extrapleural pneumonectomy was 9 days (range, 5 to 101 days). Perioperative (30-day) mortality was 5%, resulting from myocardial infarction (two patients), pulmonary embolus (two), respiratory failure (one), and cardiac herniation through the pericardial defect (one). Morbidity was 22%. Fifteen patients (12.5%) experienced one or more of the following major complications: hemorrhage (four patients), respiratory failure (four), pneumonia (five), disrupted diaphragmatic patch (one), perforated duodenal ulcer (two), empyema (one), upper GI tract bleed (one), and deep venous thrombosis (three). cialis professional

Median overall survival was 21 months (range, 1 to 96 months). The 2- and 5-year survival rates were 45% and 22%, respectively (Fig l). A multivariate Cox proportional hazards model revealed that epithelial cell type and lack of lymph node involvement (hilar, mediastinal, and intrapulmonary) were significant positive prognostic factors. The subset of cases with pure epithelial cell type tumors (n=67; 59%) were associated with significantly longer survival (2- and 5-year survival rates of 65% and 27%, respectively) than the subset (n=47) with either sarcomatous or mixed- histologic-type tumors (20% and 0%, respectively; p=0.0001). The subset of patients with negative lymph nodes in the pathologic specimen (n=66) survived significantly longer (2- and 5-year survival rates of 50% and 25%, respectively) than did the subset with nodal involvement (n=48; 35% and 0%, respectively; p=0.02). Within the epithelia cell type patient subgroup, node status further stratified survival (Fig 2). Of the 67 patients with epithelial tumors, the 39 with node-negative specimens had significantly better survival rates (74% 2-year survival, 39% 5-year) than the 28 patients with node-positive specimens (52% 2-year survival, 10% 5-vear survival, p=0.002).

Figure 1. Kaplan-Meier survival curve for all patients surviving surgery (n=114). Median survival=21 months. Reprinted with permission from Sugarbaker et al.Figure 1. Kaplan-Meier survival curve for all patients surviving surgery (n=114). Median survival=21 months. Reprinted with permission from Sugarbaker et al. 

Figure 2. Kaplan-Meier survival curve for patients with epithelial tumors with node-negative vs node-positive pathologic specimens. Patients with negative nodes had a longer survival (p=0.002). Reprinted with permission from Sugarbaker et alFigure 2. Kaplan-Meier survival curve for patients with epithelial tumors with node-negative vs node-positive pathologic specimens. Patients with negative nodes had a longer survival (p=0.002). Reprinted with permission from Sugarbaker et al.