Evaluation of pleurectomy and decortication efficiency of malignant mesothelioma

Malignant pleural mesothelioma (MPM) is a rare and aggressive primary malignant tumor of the mesothelial covering and mostly assosiated with occupational and enviromental asbestos exposure, 90% of which originate from the pleura, develop from the serous surfaces of the peritoneum and pericardium, and rarely from the tunica vaginalis in the testis. Occupational or environmental contact is reported 70-90%. Although it is seen at earlier ages due to occupational asbestos exposure, the risk increases more with age. According to WHO mortality data, the age-adjusted mortality rate between 1994 and 2008 was 4.9 per million, the mean age at death was 70, and the male-female ratio was 3.6:1. In large case series, life expectancy was found 7-17 months . There are epitheloid, sarcomatoid and biphasic subtypes. The epithelioid type is the most common type and has a better prognosis than biphasic and sarcomatoid tumors. MPM is rapidly spreading all over the world, which has significantly increased efforts to treat mesothelioma in recent years. Surgery, chemotherapy and radiotherapy are tried alone or in combination in malignant pleural mesothelioma, which still does not have a standard treatment.Surgery is performed as extrapleural pneumonectomy (EPP) or extended pleurectomy/decortication for macroscopic complete resection.Today, the thoughts that chemotherapy and radiotherapy combined with surgical treatment increase overall survival suggest that this combination may be beneficial. Malign pleural effusion (MPE) is the most common and widely accepted indication for chemical pleurodesis.The most commonly used sclerosing agent is talc. Talc pleurodesis is obliteration of the pleural space. By creating inflammation in the pleura, mesothelial damage and stimulation of fibroblast proliferation allow the parietal and visceral pleural sheets to adhere to each other. It is a palliative form of treatment in MPM. The aim of this study is to evaluate the overall survival times of patients admitted to our clinic with the diagnosis of MPM, both with pleurectomy and decortication and with talc pleuridesis, and to determine other factors that may affect their overall survival. Totally 72 patients, 36 patients who underwent P/D and 36 patients who underwent talc pleurodesis, were included in our study in order to investigate the factors that may affect the average survival and average survival of the patients. In our study, the type of surgery performed, tumor side, cytological examination results, the effect of chemotherapy and radiotherapy on survival were not found to be statistically significant, but overall survival in the P/D group was found to be statistically significantly better than the talc pleurodesis group. Keywords:Surgery, decortication, pleurectomy, malignant pleural mesothelioma, talc, pleuredesis