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Pleurectomy-decortication in malignant pleural mesothelioma: are different surgical techniques associated with
Giuseppe Marulli1, Cristiano Breda2, Paolo Fontana2
1Thoracic Surgery Unit, University of Padova, Padova, Italy.
Objectives:
The potential benefit of surgery for malignant pleural mesothelioma (MPM), especially concerning pleurectomy/decortication (P/D), is unclear from the literature. The aim of this study was to evaluate the outcome after multimodality treatment of MPM involving different types of P/D and to analyse the prognostic factors.
Methods:
We reviewed 314 patients affected by MPM who were operated on in 11 Italian centres from 1 January 2007 to 11 October 2014.
Results:
The characteristics of the population were male/female ratio: 3.7/1, and median age at operation was 67.8 years. The epithelioid histotype was observed in 79.9% of patients; neoadjuvant chemotherapy was given to 57% of patients and Stage III disease was found following a pathological analysis in 62.3% of cases. A total of 162 (51.6%) patients underwent extended P/D (EP/D); 115 (36.6%) patients had P/D and 37 (11.8%) received only a partial pleurectomy. Adjuvant radiotherapy was delivered in 39.2% of patients. Median overall survival time after surgery was 23.0 [95% confidence interval (CI): 19.6-29.1] months. On multivariable (Cox) analysis, pathological Stage III-IV [ P = 0.004, hazard ratio (HR):1.34; 95% CI: 1.09-1.64], EP/D and P/D ( P = 0.006, HR for EP/D: 0.46; 95% CI: 0.29-0.74; HR for P/D: 0.52; 95% CI: 0.31-0.87), left-sided disease ( P = 0.01, HR: 1.52; 95% CI: 1.09-2.12) and pathological status T4 ( P = 0.0003, HR: 1.38; 95% CI: 1.14-1.66) were found to be independent significant predictors of overall survival.
Conclusions:
Whether the P/D is extended or not, it shows similarly good outcomes in terms of early results and survival rate. In contrast, a partial pleurectomy, which leaves gross tumour behind, has no impact on survival.
Insights
Pleurectomy/decortication (P/D) surgery offers good outcomes for malignant pleural mesothelioma (MPM). Extended or standard P/D improves survival, while partial pleurectomy does not significantly impact survival rates.
Area of Science:
- Thoracic Surgery
- Oncology
- Malignant Pleural Mesothelioma Research
Background:
- The surgical benefit of pleurectomy/decortication (P/D) for malignant pleural mesothelioma (MPM) remains debated.
- Multimodality treatment strategies are crucial for managing MPM.
Purpose of the Study:
- To evaluate outcomes of MPM multimodality treatment involving different P/D types.
- To identify prognostic factors influencing survival in MPM patients undergoing surgery.
Main Methods:
- Retrospective review of 314 MPM patients from 11 Italian centers (2007-2014).
- Analysis of patient characteristics, surgical procedures (extended P/D, P/D, partial pleurectomy), and adjuvant therapies.
- Multivariable Cox regression analysis to identify independent prognostic factors.
Main Results:
- Median overall survival was 23.0 months.
- Extended P/D and standard P/D were associated with significantly improved survival (HR: 0.46 and 0.52, respectively).
- Pathological Stage III-IV, left-sided disease, and T4 status were independent negative predictors of survival.
Conclusions:
- Both extended and standard P/D demonstrate comparable positive outcomes in MPM treatment.
- Partial pleurectomy, without complete tumor removal, does not improve survival in MPM patients.