Pleurectomy-decortication in malignant pleural mesothelioma: are different surgical techniques associated with different outcomes? Results from a multicentre study

Giuseppe Marulli, Cristiano Breda, Paolo Fontana, Giovanni Battista Ratto, Giacomo Leoncini, Marco Alloisio, Maurizio Infante, Luca Luzzi, Piero Paladini, Alberto Oliaro, Enrico Ruffini, Mauro Roberto Benvenuti, Gianluca Pariscenti, Lorenzo Spaggiari, Monica Casiraghi, Michele Rusca, Paolo Carbognani, Luca Ampollini, Francesco Facciolo, Giovanni LeuzziFelice Mucilli, Pierpaolo Camplese, Paola Romanello, Egle Perissinotto, Federico Rea

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)63-69
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume52
Issue number1
DOIs
Publication statusPublished - Jul 1 2017

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    Marulli, G., Breda, C., Fontana, P., Ratto, G. B., Leoncini, G., Alloisio, M., Infante, M., Luzzi, L., Paladini, P., Oliaro, A., Ruffini, E., Benvenuti, M. R., Pariscenti, G., Spaggiari, L., Casiraghi, M., Rusca, M., Carbognani, P., Ampollini, L., Facciolo, F., ... Rea, F. (2017). Pleurectomy-decortication in malignant pleural mesothelioma: are different surgical techniques associated with different outcomes? Results from a multicentre study. European Journal of Cardio-thoracic Surgery, 52(1), 63-69. https://doi.org/10.1093/ejcts/ezx079