Short‐term outcomes of pleurectomy decortication and extrapleural pneumonectomy in mesothelioma

Abstract

Background/Objectives We evaluated postoperative mortality and complications after extrapleural pneumonectomy (EPP) and pleurectomy decortication (P/D) to better understand their effectiveness in malignant pleural mesothelioma (MPM). Methods A meta‐analysis was done to evaluate 30‐day mortality and postoperative complications. In addition, in‐patients data of 500 eligible patients with MPM who underwent EPP or P/D was extracted from the New York Statewide Planning and Research Cooperative System (SPARCS). Multivariate analyses and propensity matching were used to compare in‐hospital mortality and postoperative complications in EPP vs P/D. Results The meta‐analysis showed a statistically significant difference in 30‐day mortality (5% [95% CI: 4‐6] vs P/D 2% [95% CI: 1‐3]), proportion of complications (46% [95% CI: 36‐56] vs 24% [95% CI: 15‐34]) and postoperative arrhythmias (20% [95% CI: 12‐31] vs 5% [95% CI: 2‐8]) for EPP vs P/D. In‐hospital mortality (OR adj: 2.6; 95% CI: 0.86‐7.75) and postoperative complications (OR adj: 1.1; 95% CI: 0.68‐1.86) were not different in EPP compared with P/D while supraventricular arrhythmia was significantly more frequent after EPP vs P/D (OR adj: 5.2; 95% CI: 2.34‐11.33). Conclusions Postoperative mortality, postoperative complications, and particularly supraventricular arrhythmia are less frequent after P/D vs EPP. P/D, a less invasive surgery, may provide a better option when technically feasible for patients with MPM.

Locoregional control and toxicity after pleurectomy/decortication and intensity‐modulated pleural radiation therapy in patients with malignant pleural mesothelioma

“…reported to be constant in the setting of multimodality therapy. [9][10][11] Allen et al reported 46.1% of radiotherapyrelated deaths in patients who received IMRT after EPP, with a V20 limited to 20% and a mean lung dose (MLD) of 15 Gy. 12 Moreover, in a multicenter phase 2 study trial, postoperative hemithoracic high-dose radiotherapy in the context of trimodality therapy failed to significantly improve locoregional relapse-free survival compared with no further treatment after EPP.…”

Malignant Mesothelioma: Has Anything Changed?

“…Seventy-two percent of surveyed surgeons routinely performing MPM procedures agreed that P/D should be defined as resection of the visceral and parietal pleura, and the authors coined the term "extended P/D" to refer to P/D additionally involving resection of the pericardium or diaphragm and dissection of the pleural surfaces along the interlobar fissures extending to the hila to facilitate maximal cytoreduction. 64 While EPP and P/D each offers its own distinct advantages and disadvantages and a considerable amount of controversy exists regarding the preferred surgical approach, [65][66][67][68][69][70][71][72][73] the goal of each procedure is to achieve maximal cytoreduction via macroscopic complete resection (MCR), defined as <1 cm of residual tumor after resection. Selection of patients for surgical intervention is critical as the ideal candidates would have early-stage, less bulky disease and favorable prognostic signs (i.e., good performance status, epithelial histology); however, as mentioned previously, staging of MPM can be very challenging and more extensive disease can be found on exploratory thoracoscopy.…”

“…The review concluded that P/D may provide a safer option when possible for MPM patients. 73 To date, no studies have compared EPP and P/D outcomes in a randomized fashion with quantitative measurement of disease volume to normalize pathologic disease stage.…”

Identification of Malignant Mesothelioma Risk Factors through Association Rule Mining

“…The identification of risk factors associated with mesothelioma may prevent patients from gone into the high danger of disease. The comorbidities associated with malignant mesothelioma are cardiovascular diseases [63],cancer-related emotional distress [64], pulmonary, neurologic, diabetes, anemia, psychiatric disorders, hypothyroidism, metastatic cancer, weight loss, and electrolyte disorders [65]. V. Conclusion Epidemiology of diseases at early stages assumes as a substantial measure for patient's appropriate treatment.…”