The effects of an intentional transition from extrapleural pneumonectomy to extended pleurectomy/decortication

Annabel J. Sharkey, Sara Tenconi, Apostolos Nakas, David A. Waller

Research output: Contribution to journalArticle

Abstract

Objectives: For many years, extrapleural pneumonectomy (EPP) was the operation of choice for the radical management of pleuralmesothelioma in the UK. However, doubts surrounding the efficacy of EPP, and the change in demographics of the affected population,have prompted a transition in our practice towards extended pleurectomy/decortication (EPD). The aim of this study was to determine theeffects an intentional transition from EPP to EPD has had on patient outcome.Methods: Data from 362 patients undergoing radical surgery (229 EPD, 133 EPP) during 1999-2014 were included. Demographics andoutcome were compared between the two groups; EPP versus EPD.Results: The median age of patients undergoing EPD was significantly higher than those undergoing EPP [57 years (range 14-70 years) vs65 years (range 42-81 years), P < 0.001]. There was a significantly higher proportion of patients with performance status ≥1 in the EPDgroup (46.3 vs 35.4%, P = 0.047). There was no difference in the median length of hospital stay between the two groups [14 days (range 1-133 days) vs 13 days (range 0-93 days), P = 0.409]. There was also no difference between the groups in terms of in-hospital mortality (EPP5.3% and EPD 6.6%, P = 0.389), 30-day mortality [EPP 8 (6.0%) and EPD 8 (3.5%), P = 0.294] or 90-day mortality [EPP 18 (13.5%) and EPD 21(9.2%), P = 0.220]. There was a significantly higher early reoperation rate in the EPP group (15.0 vs 6.2%, P = 0.008) but a significantly higherlate reoperation rate in the EPD group (0.8 vs 5.3%, P = 0.037). There was no significant difference in overall survival or disease-free intervalbetween the two groups (P = 0.899 and P = 0.399, respectively). However, overall survival was significantly greater in patients over the ageof 65 undergoing EPD (12.5 vs 4.7 months, P = 0.001).Conclusion: The transition from EPP to EPD in our standard practice has enabled us to operate on more elderly, frail patients withno significant increase in use of hospital resources, and without detriment to overall survival.

Original languageEnglish
Pages (from-to)1632-1641
Number of pages10
JournalEuropean Journal of Cardio-thoracic Surgery
Volume49
Issue number6
DOIs
Publication statusPublished - Jun 13 2016

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Pneumonectomy
Reoperation
Length of Stay
Demography
Frail Elderly
Survival
Mortality
Hospital Mortality
Disease-Free Survival

Keywords

  • Extended pleurectomy/decortication
  • Extrapleural pneumonectomy
  • Mesothelioma
  • Pleural mesothelioma
  • Survival
  • Thoracic surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

The effects of an intentional transition from extrapleural pneumonectomy to extended pleurectomy/decortication. / Sharkey, Annabel J.; Tenconi, Sara; Nakas, Apostolos; Waller, David A.

In: European Journal of Cardio-thoracic Surgery, Vol. 49, No. 6, 13.06.2016, p. 1632-1641.

Research output: Contribution to journalArticle

Sharkey, Annabel J. ; Tenconi, Sara ; Nakas, Apostolos ; Waller, David A. / The effects of an intentional transition from extrapleural pneumonectomy to extended pleurectomy/decortication. In: European Journal of Cardio-thoracic Surgery. 2016 ; Vol. 49, No. 6. pp. 1632-1641.
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abstract = "Objectives: For many years, extrapleural pneumonectomy (EPP) was the operation of choice for the radical management of pleuralmesothelioma in the UK. However, doubts surrounding the efficacy of EPP, and the change in demographics of the affected population,have prompted a transition in our practice towards extended pleurectomy/decortication (EPD). The aim of this study was to determine theeffects an intentional transition from EPP to EPD has had on patient outcome.Methods: Data from 362 patients undergoing radical surgery (229 EPD, 133 EPP) during 1999-2014 were included. Demographics andoutcome were compared between the two groups; EPP versus EPD.Results: The median age of patients undergoing EPD was significantly higher than those undergoing EPP [57 years (range 14-70 years) vs65 years (range 42-81 years), P < 0.001]. There was a significantly higher proportion of patients with performance status ≥1 in the EPDgroup (46.3 vs 35.4{\%}, P = 0.047). There was no difference in the median length of hospital stay between the two groups [14 days (range 1-133 days) vs 13 days (range 0-93 days), P = 0.409]. There was also no difference between the groups in terms of in-hospital mortality (EPP5.3{\%} and EPD 6.6{\%}, P = 0.389), 30-day mortality [EPP 8 (6.0{\%}) and EPD 8 (3.5{\%}), P = 0.294] or 90-day mortality [EPP 18 (13.5{\%}) and EPD 21(9.2{\%}), P = 0.220]. There was a significantly higher early reoperation rate in the EPP group (15.0 vs 6.2{\%}, P = 0.008) but a significantly higherlate reoperation rate in the EPD group (0.8 vs 5.3{\%}, P = 0.037). There was no significant difference in overall survival or disease-free intervalbetween the two groups (P = 0.899 and P = 0.399, respectively). However, overall survival was significantly greater in patients over the ageof 65 undergoing EPD (12.5 vs 4.7 months, P = 0.001).Conclusion: The transition from EPP to EPD in our standard practice has enabled us to operate on more elderly, frail patients withno significant increase in use of hospital resources, and without detriment to overall survival.",
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N2 - Objectives: For many years, extrapleural pneumonectomy (EPP) was the operation of choice for the radical management of pleuralmesothelioma in the UK. However, doubts surrounding the efficacy of EPP, and the change in demographics of the affected population,have prompted a transition in our practice towards extended pleurectomy/decortication (EPD). The aim of this study was to determine theeffects an intentional transition from EPP to EPD has had on patient outcome.Methods: Data from 362 patients undergoing radical surgery (229 EPD, 133 EPP) during 1999-2014 were included. Demographics andoutcome were compared between the two groups; EPP versus EPD.Results: The median age of patients undergoing EPD was significantly higher than those undergoing EPP [57 years (range 14-70 years) vs65 years (range 42-81 years), P < 0.001]. There was a significantly higher proportion of patients with performance status ≥1 in the EPDgroup (46.3 vs 35.4%, P = 0.047). There was no difference in the median length of hospital stay between the two groups [14 days (range 1-133 days) vs 13 days (range 0-93 days), P = 0.409]. There was also no difference between the groups in terms of in-hospital mortality (EPP5.3% and EPD 6.6%, P = 0.389), 30-day mortality [EPP 8 (6.0%) and EPD 8 (3.5%), P = 0.294] or 90-day mortality [EPP 18 (13.5%) and EPD 21(9.2%), P = 0.220]. There was a significantly higher early reoperation rate in the EPP group (15.0 vs 6.2%, P = 0.008) but a significantly higherlate reoperation rate in the EPD group (0.8 vs 5.3%, P = 0.037). There was no significant difference in overall survival or disease-free intervalbetween the two groups (P = 0.899 and P = 0.399, respectively). However, overall survival was significantly greater in patients over the ageof 65 undergoing EPD (12.5 vs 4.7 months, P = 0.001).Conclusion: The transition from EPP to EPD in our standard practice has enabled us to operate on more elderly, frail patients withno significant increase in use of hospital resources, and without detriment to overall survival.

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