TY - JOUR
T1 - Pleurectomy-decortication in malignant pleural mesothelioma
T2 - Are different surgical techniques associated with different outcomes? Results from a multicentre study
AU - Marulli, Giuseppe
AU - Breda, Cristiano
AU - Fontana, Paolo
AU - Ratto, Giovanni Battista
AU - Leoncini, Giacomo
AU - Alloisio, Marco
AU - Infante, Maurizio
AU - Luzzi, Luca
AU - Paladini, Piero
AU - Oliaro, Alberto
AU - Ruffini, Enrico
AU - Benvenuti, Mauro Roberto
AU - Pariscenti, Gianluca
AU - Spaggiari, Lorenzo
AU - Casiraghi, Monica
AU - Rusca, Michele
AU - Carbognani, Paolo
AU - Ampollini, Luca
AU - Facciolo, Francesco
AU - Leuzzi, Giovanni
AU - Mucilli, Felice
AU - Camplese, Pierpaolo
AU - Romanello, Paola
AU - Perissinotto, Egle
AU - Rea, Federico
PY - 2017/7/1
Y1 - 2017/7/1
N2 - 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.
AB - 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.
KW - Malignant pleural mesothelioma
KW - Pleurectomy-decortication
KW - Prognostic factors
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U2 - 10.1093/ejcts/ezx079
DO - 10.1093/ejcts/ezx079
M3 - Article
AN - SCOPUS:85021704064
VL - 52
SP - 63
EP - 69
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
SN - 1010-7940
IS - 1
ER -