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Extrapleural pneumonectomy: still indicated?

Andreas Domen¹, Lawek Berzenji¹, Jeroen M H Hendriks¹

¹Department of Thoracic and Vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium.

Translational Lung Cancer Research

|November 20, 2018

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Extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MPM) is increasingly questioned. Current evidence suggests extended pleurectomy/decortication (eP/D) may offer similar survival with lower risks, though definitive trials are lacking.

Area of Science:

Thoracic Surgery
Oncology
Malignant Pleural Mesothelioma (MPM) Research

Background:

Optimal treatment for malignant pleural mesothelioma (MPM) remains under investigation.
Surgery is a key component of multimodal therapy for MPM, aiming for maximal tumor removal and symptom relief.

Purpose of the Study:

To critically evaluate the current indications for extrapleural pneumonectomy (EPP) in the surgical management of resectable MPM.
To compare the efficacy and safety of EPP versus extended pleurectomy/decortication (eP/D) for MPM.

Main Methods:

Review of existing literature, including retrospective studies and meta-analyses comparing EPP and eP/D.
Analysis of perioperative mortality, postoperative morbidity, and long-term survival rates associated with each procedure.

Keywords:

Malignant pleural mesothelioma (MPM)extrapleural pneumonectomy (EPP)pleurectomy decortication (P/D)surgery

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Main Results:

Recent studies indicate eP/D may achieve similar or better long-term survival compared to EPP.
EPP is associated with higher perioperative mortality and postoperative morbidity.

Conclusions:

A shift towards preferring eP/D for resectable MPM is observed in recent literature.
Level A evidence from randomized controlled trials is lacking to definitively favor either EPP or eP/D.