Surgical treatment of asbestos-related disease of the chest

Our plain-English summary of Surgical treatment of asbestos-related disease of the chest, by L.P. Faber (The Surgical Clinics of North America, 1988).

The study

• Author: L.P. Faber
• Journal: The Surgical Clinics of North America
• Published: 1988;68(3):525-43
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000904).

Abstract

Thoracic surgeons are asked to evaluate various diseases related to asbestos, including benign pleural plaques, malignant mesothelioma, and lung cancer. The benign localized mesothelioma is usually considered in the differential diagnosis of pleural tumors, but it is not related to asbestos exposure. Benign pleural plaques can be diagnosed by history and radiologic studies, and surgery offers no therapeutic benefit. Diffuse malignant mesothelioma is currently an incurable tumor, but pleurectomy can afford some palliation. Extrapleural pneumonectomy can be accomplished with an acceptable mortality, but long-term results do not justify its routine use. Lung cancer in those exposed to asbestos fibers is treated no differently than when it occurs in the general population.

In plain English

This article was a thoracic surgeon's review of how surgeons evaluate and treat three asbestos-associated chest diseases: benign pleural plaques, malignant mesothelioma and lung cancer. It also reported the author's own hospital series at Rush-Presbyterian-St. Luke's Medical Center in Chicago: 68 surgical patients with diffuse malignant mesothelioma, of whom only 50 per cent had knowingly been exposed to asbestos. Among 33 patients who had extrapleural pneumonectomy (pleuropneumonectomy), median survival was 13.5 months and 9 patients (27 per cent) survived 2 years. Three of these patients (9 per cent) died from the operation, and none were cured. In this group, the 17 patients given additional therapy after surgery averaged 17.5 months of survival. The author wrote that this was no better than the 21.7 months of 13 patients who survived the operation without additional therapy. Within the same pneumonectomy group, survival differences among the three tissue types of tumor were not statistically significant. Among 35 patients who had pleurectomy, median survival was 10.0 months, with three operative deaths (8.6 per cent). The author concluded that pleuropneumonectomy is not an effective form of palliation for diffuse malignant mesothelioma.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of surgical management of asbestos-related chest disease, including a description of the author's institutional surgical series for diffuse malignant mesothelioma
• Who was studied: 68 surgical patients with diffuse malignant mesothelioma at Rush-Presbyterian-St. Luke's Medical Center, Chicago (figure covers 1958 to 1988): 33 treated by extrapleural pneumonectomy and 35 by pleurectomy
• Exposure: Asbestos exposure in general. Chrysotile, crocidolite and amosite are discussed as background. In the author's mesothelioma series, only 50 per cent of patients had knowingly been exposed to asbestos.
• Main results:
  • Extrapleural pneumonectomy group (33 patients): median survival 13.5 months
  • Extrapleural pneumonectomy group: Kaplan-Meier mean estimated survival 22.2 months
  • Extrapleural pneumonectomy group: 9 patients (27 per cent) survived 2 years, and no patients have been cured
  • Extrapleural pneumonectomy group: one patient was alive and free of disease at 48 months
  • Extrapleural pneumonectomy group: three operative deaths (9 per cent)
  • Extrapleural pneumonectomy group: major complications in 8 patients
  • Extrapleural pneumonectomy group: 17 patients received adjunctive therapy (chemotherapy, radiation, or both) after the operation
  • Extrapleural pneumonectomy group: patients given postoperative adjunctive therapy had an average survival of 17.5 months, which the author called no better than the 21.7 months of the 13 patients who survived the operation but received no adjunctive therapy
  • Extrapleural pneumonectomy group: survival differences among the three histologic types were not statistically significant
  • Pleurectomy group (35 patients): median survival 10.0 months
  • Pleurectomy group: Kaplan-Meier mean estimated survival 18.7 months, with three operative deaths (8.6 per cent)
  • With the one-stage biopsy technique, the final diagnosis turned out to be metastatic adenocarcinoma to the pleura in only one case in the surgical series
• The authors' conclusion: The author concluded that pleuropneumonectomy is not an effective form of palliation for diffuse malignant mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Plaques, Mesothelioma, Lung Cancer, Localized Malignant Mesothelioma, Differential Diagnosis, Asbestos Exposure, Extrapleural Pneumonectomy (EPP).

Related studies

• Asbestos-related chest diseases: plain radiographic findings — W.T. Miller, W.B. Gefter, et al. (1992)
• Thoracic surgical problems in asbestos-related disorders — E.A. Gaensler, T.C. McLoud, et al. (1985)
• Chest pain in asbestos-exposed individuals with benign pleural and parenchymal disease — S. Mukherjee, N. de Klerk, et al. (2000)
• Asbestos-related diseases in construction carpenters — M. García-Closas, D.C. Christiani (1995)
• Comparison of independent randomised reading of radiographs with direct progression scoring for assessing change in asbestos-related pulmonary and pleural lesions — G.H. McMillan, C.E. Rossiter, et al. (1982)
• Multiplane gallium tomography in assessment of occupational chest diseases — E.M. Cordasco, J. O'Donnell, et al. (1990)

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