[Problems of diagnosis and surgical treatment in pleural mesothelioma]

Twelve patients with pleural mesothelioma were operated on over a period of 6 years. Two of six patients with localized type died of recurrence. One of two patients showed fibrous form with low grade malignancy and the other showed a mixed type on their histological examination. The remaining 4 patients are alive and well with the combined resection of the tumor and the chest wall for the past 2 to 3 years. Three of six patients with diffuse type had an operation of pleuropneumonectomy with the resection of adjacent structures such as the diaphragm, SVC and the chest wall. One of them who had had the implantation at the chest wall where the biopsy needle entered, developed peritoneal mesothelioma. At laparotomy, numerous nodules were found. He was given 470 mg of CDDP and 80 mg of ADM into the cavity through the tubes. Though this patient died eventually, nodules were found to be macroscopically disappeared at autopsy. But they were left in the area where the drugs could not reach. The other two patients are alive and well for 16 to 22 months after the operation. The remaining 3 patients, who did not have the diagnosis preoperatively, died of cardio-pulmonary insufficiency due to local compression by the huge tumor at 3 months, 7 months and 2 years respectively after the exploratory thoracotomy. It is concluded that wide resection including the rib for a case with solitary lesion and early thoracotomy for a case with undiagnosed chest fluid, followed by pleuropneumonectomy or pleurectomy and post-operative local chemotherapy, are recommended for this malignant disease.