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- W2027672399 abstract "Introduction: Malignant pleural mesothelioma is a relatively rare but aggressive form of malignancy with a dismal prognosis of less than 12 months from the time of surgery. Therapeutic surgical intervention includes extrapleural pneumonectomy and pleurectomy/decortication (P/D). The present review aimed to assess the safety and efficacy of these two procedures, and to compare their perioperative and long-term outcomes. Methods: Systematic reviews were conducted using 6 online databases to assess the safety and efficacy of extrapleural pneumonectomy and pleurectomy/decortication as defined by the International Association for the Study of Lung Cancer (IASLC). Comparative clinical outcomes were assessed and meta-analysed where possible. Results: Thirty-four studies on extrapleural pneumonectomy reported median overall survival rates of 9.4 – 27.5 months, with a perioperative mortality of 0 – 11.8%. Thirty-four studies on P/D were divided into 12 on ‘extended P/D’, 8 on ‘P/D’ and 14 on ‘partial P/D’ according to IASLC criteria. Perioperative mortality was higher in the more aggressive ‘extended P/D’ group but patients who underwent this procedure achieved longer overall survival. Direct comparative outcomes of extrapleural pneumonectomy and ‘extended P/D’ were reported in 7 studies, which demonstrated significantly lower perioperative mortality (2.9% vs 6.8%, p=0.02) and morbidity (27.9% vs 62.0%, p<0.0001) for patients who underwent extended P/D. Median overall survival ranged between 13 – 29 months for extended P/D and 12 – 22 months for EPP, with a trend favouring extended P/D. Discussion: Extrapleural pneumonectomy and P/D are both feasible surgical options that can be performed safely at specialised centres. However, morbidity remains relatively high in these cytoreductive procedures and appropriate patient selection is paramount. Existing data suggests that ‘extended’ P/D may achieve equal or superior long-term survival with less perioperative morbidity." @default.
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- W2027672399 date "2015-01-01" @default.
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- W2027672399 title "Surgical management of malignant pleural mesothelioma" @default.
- W2027672399 doi "https://doi.org/10.1016/j.hlc.2014.12.145" @default.
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