VATS Pleurectomy Decortication Is a Reasonable Alternative for Higher Risk Patients in the Management of Malignant Pleural Mesothelioma: An Analysis of Short-Term Outcomes

Abstract

Surgery is a mainstay of treatment allowing for debulking of tumor and expansion of the lung for improvement in median survival and quality of life for patients with malignant pleural mesothelioma (MPM). Although optimal surgical technique remains open for debate—extrapleural pneumonectomy (EPP) vs. pleurectomy/decortication (P/D)—minimally invasive surgery (VATS-P/D) remains underutilized in the management of MPM. We examined whether VATS-P/D is a feasible alternative to EPP and P/D. We evaluated the New York Statewide Planning and Research Cooperative System (SPARCS) from 2007–2017 to assess the short-term complications of EPP vs. P/D, including a subanalysis of open P/D vs. VATS-P/D. There were 331 patients with open surgery; 269 with P/D and 62 with EPP. There were 384 patients with P/D; 269 were open and 115 VATS. Rates of any complication were similar between EPP and P/D patients, but EPP had significantly higher rates of cardiovascular complications. After adjusting for confounders, those with a VATS approach were less likely to have any complication, compared to an open approach and significantly less likely to have a pulmonary complication. VATS-P/D remains a viable alternative to radical surgery in MPM patients allowing for improved short-term outcomes.

Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach

“…Beside OS, therapy-associated morbidity and quality of life need to be assessed when choosing the optimal treatment modality. Several studies report a significantly reduced postoperative morbidity for patients following lung-sparing surgery compared to EPP ( 13 , 21 , 32 , 33 ). Perioperative morbidity was significantly lower in the present EPD/HITOC cohort compared to our EPP cohort and also compared to a rather high number (49%) of grade 3 or 4 adverse events reported in the SMART trial ( 24 ).…”

Surgical Management of Malignant Pleural Mesothelioma: From the Past to the Future

“…For this reason, in the last decades, the surgical approach is mainly used as cytoreduction with improved survival, but with the necessity at least to combine with a bimodal/trimodal treatment, although the income of the novel strategies as immunotherapy, are suggesting a multimodal approach [40,62,74,75]. The debate regarding the possible surgical approach as the closest to the radicality for MPM is still opened [76,77]. In particular, the believers for EPP as the most oncologically correct approach, strongly support the theory that a near-complete surgical resection associated with chemo-or high-dose aRT may be the best treatment for earlier stages [78].…”

Malignant Mesothelioma

“…With the development of immune checkpoint therapy, Kitajima et al also demonstrated how hybrid imaging modalities could contribute to therapy response assessment and predict prognosis [ 13 ]. Among other treatment strategies, Lee et al showed how minimally invasive surgery may help manage short-term outcomes of patients with MM [ 14 ], while Di Gregorio et al revealed how metabolomic changes are associated with clinical outcomes following radical hemithoracic radiotherapy [ 15 ]. In the search for new targets, Yang et al demonstrated that the exploration of aberrant biochemical networks and potential drug vulnerabilities induced by tumor suppressor loss provide interesting prospects for the treatment of MM [ 16 ].…”