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 Leuzzi & 5 others Felice Mucilli, Pierpaolo Camplese, Paola Romanello, Egle Perissinotto, Federico Rea

Research output: Contribution to journalArticle

5 Citations (Scopus)

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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Multicenter Studies
Confidence Intervals
Survival
Adjuvant Radiotherapy
Population Characteristics
Malignant Mesothelioma
Survival Rate
Drug Therapy
Neoplasms

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Pleurectomy-decortication in malignant pleural mesothelioma : are different surgical techniques associated with different outcomes? Results from a multicentre study. / Marulli, Giuseppe; Breda, Cristiano; Fontana, Paolo; Ratto, Giovanni Battista; Leoncini, Giacomo; Alloisio, Marco; Infante, Maurizio; Luzzi, Luca; Paladini, Piero; Oliaro, Alberto; Ruffini, Enrico; Benvenuti, Mauro Roberto; Pariscenti, Gianluca; Spaggiari, Lorenzo; Casiraghi, Monica; Rusca, Michele; Carbognani, Paolo; Ampollini, Luca; Facciolo, Francesco; Leuzzi, Giovanni; Mucilli, Felice; Camplese, Pierpaolo; Romanello, Paola; Perissinotto, Egle; Rea, Federico.

In: European Journal of Cardio-thoracic Surgery, Vol. 52, No. 1, 01.07.2017, p. 63-69.

Research output: Contribution to journalArticle

Marulli, G, Breda, C, Fontana, P, Ratto, GB, Leoncini, G, Alloisio, M, Infante, M, Luzzi, L, Paladini, P, Oliaro, A, Ruffini, E, Benvenuti, MR, Pariscenti, G, Spaggiari, L, Casiraghi, M, Rusca, M, Carbognani, P, Ampollini, L, Facciolo, F, Leuzzi, G, Mucilli, F, Camplese, P, Romanello, P, Perissinotto, E & 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, vol. 52, no. 1, pp. 63-69. https://doi.org/10.1093/ejcts/ezx079
Marulli, Giuseppe ; Breda, Cristiano ; Fontana, Paolo ; Ratto, Giovanni Battista ; Leoncini, Giacomo ; Alloisio, Marco ; Infante, Maurizio ; Luzzi, Luca ; Paladini, Piero ; Oliaro, Alberto ; Ruffini, Enrico ; Benvenuti, Mauro Roberto ; Pariscenti, Gianluca ; Spaggiari, Lorenzo ; Casiraghi, Monica ; Rusca, Michele ; Carbognani, Paolo ; Ampollini, Luca ; Facciolo, Francesco ; Leuzzi, Giovanni ; Mucilli, Felice ; Camplese, Pierpaolo ; Romanello, Paola ; Perissinotto, Egle ; Rea, Federico. / Pleurectomy-decortication in malignant pleural mesothelioma : are different surgical techniques associated with different outcomes? Results from a multicentre study. In: European Journal of Cardio-thoracic Surgery. 2017 ; Vol. 52, No. 1. pp. 63-69.
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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.",
author = "Giuseppe Marulli and Cristiano Breda and Paolo Fontana and Ratto, {Giovanni Battista} and Giacomo Leoncini and Marco Alloisio and Maurizio Infante and Luca Luzzi and Piero Paladini and Alberto Oliaro and Enrico Ruffini and Benvenuti, {Mauro Roberto} and Gianluca Pariscenti and Lorenzo Spaggiari and Monica Casiraghi and Michele Rusca and Paolo Carbognani and Luca Ampollini and Francesco Facciolo and Giovanni Leuzzi and Felice Mucilli and Pierpaolo Camplese and Paola Romanello and Egle Perissinotto and Federico Rea",
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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.

U2 - 10.1093/ejcts/ezx079

DO - 10.1093/ejcts/ezx079

M3 - Article

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 -