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Zhou N, Rice DC, Tsao AS, et al. Extrapleural Pneumonectomy Versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma. Ann Thorac Surg. 2021;113(1):200-208doi: 10.1016/j.athoracsur.2021.04.078.
Zhou, N., Rice, D. C., Tsao, A. S., Lee, P. P., Haymaker, C. L., Corsini, E. M., Antonoff, M. B., Hofstetter, W. L., Rajaram, R., Roth, J. A., Swisher, S. G., Vaporciyan, A. A., Walsh, G. L., Mehran, R. J., & Sepesi, B. (2022). Extrapleural Pneumonectomy Versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma. The Annals of thoracic surgery, 113(1), 200-208. https://doi.org/10.1016/j.athoracsur.2021.04.078
Zhou, Nicolas, et al. "Extrapleural Pneumonectomy Versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma." The Annals of thoracic surgery vol. 113,1 (2022): 200-208. doi: https://doi.org/10.1016/j.athoracsur.2021.04.078
Zhou N, Rice DC, Tsao AS, Lee PP, Haymaker CL, Corsini EM, Antonoff MB, Hofstetter WL, Rajaram R, Roth JA, Swisher SG, Vaporciyan AA, Walsh GL, Mehran RJ, Sepesi B. Extrapleural Pneumonectomy Versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma. Ann Thorac Surg. 2022 Jan;113(1):200-208. doi: 10.1016/j.athoracsur.2021.04.078. Epub 2021 May 08. PMID: 33971174.
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Ann Thorac Surg. 2022 Jan;113(1):200-208. doi: 10.1016/j.athoracsur.2021.04.078. Epub 2021 May 08.

Extrapleural Pneumonectomy Versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma.

The Annals of thoracic surgery

Nicolas Zhou, David C Rice, Anne S Tsao, Percy P Lee, Cara L Haymaker, Erin M Corsini, Mara B Antonoff, Wayne L Hofstetter, Ravi Rajaram, Jack A Roth, Stephen G Swisher, Ara A Vaporciyan, Garrett L Walsh, Reza J Mehran, Boris Sepesi

Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
  2. Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
  3. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
  4. Department Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
  5. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: [email protected].

PMID: 33971174 DOI: 10.1016/j.athoracsur.2021.04.078

Abstract

BACKGROUND: Whether extrapleural pneumonectomy (EPP) or extended pleurectomy/decortication (P/D) is the optimal resection for malignant pleural mesothelioma remains controversial. We therefore compared perioperative outcomes and long-term survival of patients who underwent EPP versus P/D.

METHODS: Patients with the diagnosis of malignant pleural mesothelioma who underwent either EPP or P/D from 2000 to 2019 were identified from our departmental database. Propensity score matching was performed to minimize potential confounders for EPP or P/D. Survival analysis was performed by the Kaplan-Meier method and Cox multivariable analysis.

RESULTS: Of 282 patients, 187 (66%) underwent EPP and 95 (34%) P/D. Even with propensity score matching, perioperative mortality was significantly higher for EPP than for P/D (11% vs 0%; P = .031); when adjusted for perioperative mortality, median overall survival between EPP and P/D was 15 versus 22 months, respectively (P = .276). Cox multivariable analysis for the matched cohort identified epithelioid histology (hazard ratio [HR], 0.56; P = .029), macroscopic complete resection (HR, 0.41; P = .004), adjuvant radiation therapy (HR, 0.57; P = .019), and more recent operative years (HR, 0.93; P = .011)-but not P/D-to be associated with better survival. Asbestos exposure (HR, 2.35; P = .003) and pathologic nodal disease (HR, 1.61; P = .048) were associated with worse survival.

CONCLUSIONS: In a multimodality treatment setting, P/D and EPP had comparable long-term oncologic outcomes, although P/D had much lower perioperative mortality. The goal of surgical cytoreduction should be macroscopic complete resection achieved by the safest operation a patient can tolerate.

Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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