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A systematic review of extrapleural pneumonectomy for malignant pleural mesothelioma
Christopher Q Cao1, Tristan D Yan, Paul G Bannon
1Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Australia.
Introduction:
The primary objective of the present systematic review was to evaluate the safety and efficacy of extrapleural pneumonectomy (EPP) for patients with malignant pleural mesothelioma.
Methods:
A systematic review of relevant studies identified through five online search databases was performed. Two reviewers independently appraised each study.
Results:
Thirty-four of 58 relevant studies from 26 institutions containing the most updated data were evaluated for survival and perioperative outcomes after EPP. The median overall survival varied from 9.4 to 27.5 months, and 1-, 2-, and 5-year survival rates ranged from 36 to 83%, 5 to 59%, and 0 to 24%, respectively. Overall perioperative mortality rates ranged from 0 to 11.8%, and the perioperative morbidity rates ranged from 22 to 82%. Quality of life assessments from three studies reported improvements in nearly all domains at 3 months postoperatively. Patients who underwent trimodality therapy involving EPP and adjuvant chemoradiotherapy had a median overall survival of 13 to 23.9 months.
Discussions:
The current evidence suggests that selected patients with malignant pleural mesothelioma may benefit from EPP, especially when combined with neoadjuvant or adjuvant chemotherapy and adjuvant radiotherapy.
Insights
Extrapleural pneumonectomy (EPP) shows potential benefits for select malignant pleural mesothelioma patients, especially with combined therapies. Survival rates vary, but quality of life may improve post-surgery.
Area of Science:
- Thoracic surgery
- Oncology
- Systematic review
Background:
- Malignant pleural mesothelioma is a rare and aggressive cancer.
- Extrapleural pneumonectomy (EPP) is a surgical option for this condition.
- Evaluating EPP's safety and efficacy is crucial.
Purpose of the Study:
- To systematically review the safety and efficacy of EPP for malignant pleural mesothelioma.
- To analyze survival outcomes and perioperative results.
- To assess quality of life post-EPP.
Main Methods:
- Systematic review of studies from five online databases.
- Independent appraisal of studies by two reviewers.
- Inclusion of 34 studies from 26 institutions.
Main Results:
- Median overall survival ranged from 9.4 to 27.5 months.
- Perioperative mortality was 0-11.8%, and morbidity was 22-82%.
- Quality of life improved in most domains at 3 months post-surgery.
Conclusions:
- Selected patients with malignant pleural mesothelioma may benefit from EPP.
- Combining EPP with neoadjuvant or adjuvant therapy enhances outcomes.
- Further research on optimal treatment strategies is warranted.
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