Surgery for malignant pleural mesothelioma.
Surgery for malignant pleural mesothelioma.
复制标题
DOI：
10.1586/ers.10.35
复制
发表时间：
2010-06-01
影响因子：
3.9
通讯作者：
Wolf, Andrea S
中科院分区：
文献类型：
--
作者：
Sugarbaker, David J;Wolf, Andrea S
恶性胸膜间皮瘤手术的作用包括快速诊断、术前分期和手术切除，还需要对这种罕见和侵袭性的恶性肿瘤有更多的生物学了解。在多模式治疗模式中，手术的目标是提供一个宏观的完全切除(即完全切除所有肉眼可见的肿瘤)。已经发展了两种手术：胸膜外全肺切除术和全肺切除术/去皮质。前者适用于患有晚期局部侵袭性疾病的患者；后者适用于肿瘤表面较浅的扩散，而肺和肺裂除外。如果在开胸手术中发现重要的纵隔结构(如主动脉和椎体)受累，肿瘤被归类为T4，建议行纵隔切除/去皮质手术。尽管有更晚期的疾病，但具有有利预后因素的患者子集可以通过接受胸膜外全肺切除术、化疗和/或放射三联疗法来延长生存期。手术的影响超出了诊断和切除的范围。我们对间皮瘤生物学的许多了解都是从外科病理生理学的研究中获得的，包括组织病理亚型的划分、疾病分期与生存的分层、局部(相对于系统)复发的倾向，以及上皮性与非上皮性细胞类型、胸膜外结节侵犯、肿瘤体积和手术切缘对预后的影响。在新药发现之前，未来5年临床研究的重点将放在患者选择、病理分期、分子分期和其他新的辅助疗法上的改进。
The role of surgery for malignant pleural mesothelioma encompasses the need for rapid diagnosis, preoperative staging and surgical resection, and also the need for a greater biological understanding of this rare and aggressive malignancy. In the multimodality treatment paradigm, the goal of surgery is to provide a macroscopic complete resection (i.e., complete removal of all grossly visible tumor). Two operations have evolved: extrapleural pneumonectomy and pleurectomy/decortication. The former is indicated for patients with advanced locally invasive disease; the latter for patients with more superficial spread of tumor that spares the lung and fissures. If critical mediastinal structures (e.g., aorta and vertebral bodies) are found to be involved at thoracotomy, the tumor is classified as T4, and pleurectomy/decortication is recommended. Despite having more advanced disease, a subset of patients with favorable prognostic factors can experience extended survival by undergoing trimodality therapy with extrapleural pneumonectomy, chemotherapy and/or radiation. The influence of surgery goes beyond diagnosis and resection. Much of what we know about the biology of mesothelioma has been gleaned from studying the surgical pathophysiology, including the delineation of histopathologic subtypes, disease stage stratification with survival, the propensity for local (in contrast to systemic) recurrence, as well as the prognostic effect of epithelial versus nonepithelial cell type, extrapleural nodal involvement, tumor bulk and surgical margins. Pending the discovery of new drugs, the focus of clinical research over the next 5 years will emphasize refinements in patient selection, pathologic staging, molecular staging and other novel adjuvant therapies.