Single-Center 20-Year Experience in Surgical Treatment of Malignant Pleural Mesothelioma

Abstract

Objectives: We examined a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent surgery in our institution during the last 20 years. Across this period, we changed our surgical approach to MPM, adopting extended pleurectomy and decortication (eP/D) instead of extrapleural pneumonectomy (EPP). In this study, we compare the perioperative outcomes and long-term survival of patients who underwent EPP vs. eP/D. Methods: A retrospective analysis was carried out of all the MPM patients identified from our departmental database who underwent EPP or P/D from 2000 to 2021. Clavien–Dindo criteria was adopted to score postoperative complications, while Kaplan–Meier methods and a Cox multivariable analysis were used to perform the survival analysis. Results: Of 163 patients, 78 (48%) underwent EPP and 85 (52%) eP/D. Induction chemotherapy was significantly administrated more often in the eP/D group (88% vs. 51%). Complete trimodality treatment including induction chemotherapy, radical surgery, and adjuvant radiotherapy was administered in 74% of the eP/D group versus 32% of the EPP group (p < 0.001). The postoperative morbidity rate was higher in the eP/D group (54%) compared to the EPP group (36%) (p = 0.02); no statistically significant differences were identified concerning major complications (EPP 43% vs. eP/D 24%, p = 0.08). No statistical differences were identified in 30-day mortality, 90-day mortality, median disease-free, and overall survival statistics between the two groups. The Cox multivariable analysis confirmed no induction chemotherapy (HR, 0.5; p = 0.002), RDW (HR, 1.08; p = 0.02), and the presence of pathological nodal disease (HR, 1.99; p = 0.001) as factors associated with worse survival in the entire series. Conclusions: Our data support that eP/D is a well-tolerated procedure allowing the implementation of a trimodality strategy (induction chemotherapy, surgery, and radiotherapy) in most MPM patients. When eP/D is offered in this setting, the oncological results are comparable to EPP. To obtain the best oncological results, the goal of surgical resection should be macroscopic complete resection (R0) in carefully selected patients (clinical N0).

Survival Effect of Complete Multimodal Therapy in Malignant Pleural Mesothelioma

“…Since the surgical approach is traditionally recommended for non-sarcomatoid MPM, the most common histopathological subtypes in surgical series are epithelioid and biphasic MPM [ 15 , 16 ]. Bovolato et al [ 13 ] reported that the most common histopathological subtype was epithelioid MPM, and the survival of sarcomatoid MPM was significantly worse.…”

Optimal surgery for resectable malignant pleural mesothelioma in the setting of multimodality treatment

“…Surgical techniques have gained stability in line with the increasing number of MPM cases in experienced institutions [ 8 , 12 – 16 ]. At the same time, MMT improves the survival rate.…”

“…The first half of the procedure, parietal pleurectomy, is common for EPP and P/D [ 31 ]. In considering which surgical technique to use, we summarized reports from several high-volume centers comparing EPP and P/D in multimodality treatment (Table 1 ) [ 8 , 10 , 12 – 16 , 36 , 53 – 55 ]. The superiority and inferiority of EPP vs. P/D have been reported from various viewpoints.…”