Outcomes of pleurectomy decortication in patients with biphasic mesothelioma

There are limited small, single-institution observational studies on the role of surgery in patients with biphasic mesothelioma. Herein we report a series of 147 consecutive patients with biphasic mesothelioma treated over 11 years in a high-volume single institution with intended pleurectomy decortication (PDC).

All patients with biphasic mesothelioma from 2007 to 2017 who underwent PDC in our institution were included and clinical, pathologic, and surgical information was retrieved. Kaplan-Meier estimators and log rank test were used to compare the overall survival, and Cox regression models were used to analyzed prognostic factors.

There were 117 men (80%), 99 right-sided operations (67%), and median age was 70 (range, 36-86) years. Neoadjuvant therapy was given to 36 (24.5%) and 108 (73.5%) received intraoperative heated chemotherapy. Macroscopic complete resection was achieved in 126 (86%). Tumors were assigned to stages IA (23; 18.8%), IB (60; 47.5%) II (15; 11.5%), IIIA (17; 13.1%), and IIIB (11; 9%) according to the eighth edition of the tumor-node-metastasis classification of malignant tumors. The 30- and 90-day mortality were 1.3% and 6.1%, respectively. The median overall survival in the macroscopic complete resection group was 16.7 months and 24 months in patients younger than 70 years. In a univariate analysis, factors that were associated with patient overall survival included age (P = .001), preoperative percentage forced expiratory volume in 1 second (P = .019), and adjuvant therapy (P < .001). No correlation was found between sex, neoadjuvant therapy, and nodal status to overall survival.

In selected patients with biphasic mesothelioma and good prognostic factors prolonged survival after PDC is expected.