Treatment of mesothelioma in Bloemfontein, South Africa.

OBJECTIVE Two different surgical methods for treating mesothelioma (pleurectomy and pleuro pneumonectomy) were reviewed. METHODS This was a retrospective study from 1976 to 2001. Forty-six patients, aged 35-80 years, received one of the following procedures: pleurectomy (n=29), or pleuro pneumonectomy (n=17). Pleurectomy was indicated in symptomatic patients with pain or pleural effusion while pleuro pneumonectomy was indicated in patients with Butchart stage I or II disease and an acceptable cardiopulmonary reserve. Patients received either chemotherapy, radiation, or in combination after surgery. RESULTS The mortality rate was 3.8% for pleurectomy patients and 5.8% for pleuro pneumonectomy patients. The median survival rate for pleurectomy patients was 9 months, and 12 months for pleuro pneumonectomy patients. Pleuro pneumonectomy patients experienced less morbidity and had a shorter hospital stay than pleurectomy patients. CONCLUSIONS Improved survival was obtained with both procedures. Morbidity was higher in the patients who underwent pleurectomy. Important prognostic factors include tumor stage, tumor histology, duration of symptoms, and weight loss or pain as a presenting symptom. Patients with a low tumor stage, epithelial histology, absence of pain or weight loss, and a longer onset of symptoms had the best survival rate. A trend towards improved survival in patients undergoing pleuro pneumonectomy and receiving radiation as adjuvant therapy was observed.