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.

Pleurectomy-decortication in malignant pleural mesothelioma: are different surgical techniques associated with different outcomes? Results from a multicentre study / G. Marulli, C. Breda, P. Fontana, G. Ratto, G. Leoncini, M. Alloisio, M. Infante, L. Luzzi, P. Paladini, A. Oliaro, E. Ruffini, M. Benvenuti, G. Pariscenti, L. Spaggiari, M. Casiraghi, M. Rusca, P. Carbognani, L. Ampollini, F. Facciolo, G. Leuzzi, F. Mucilli, P. Camplese, P. Romanello, E. Perissinotto, F. Rea. - In: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY. - ISSN 1010-7940. - 52:1(2017 Jul), pp. 63-69. ((Intervento presentato al 30. convegno Annual Meeting of the European Association for Cardio-Thoracic Surgery : October, 1st – 5th tenutosi a Barcelona (Spain) nel 2016 [10.1093/ejcts/ezx079].

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

M. Casiraghi;
2017

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.
Malignant pleural mesothelioma; Pleurectomy-decortication; Prognostic factors;
Settore MED/21 - Chirurgia Toracica
European Association for Cardio-Thoracic Surgery
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/868704
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