Pleurectomy/decortication for malignant pleural mesothelioma: a single-centre experience

Abstract

Objective: The role and timing of surgery for malignant pleural mesothelioma (MPM) in a multimodal setting remains a controversial topic. Earlier studies suggest that pleurectomy/decortication (P/D) achieves similar or better oncological results and overall survival rates compared to extrapleural pneumonectomy. The aim of this study is to investigate outcomes in patients undergoing P/D for MPM at a single centre.

Methods: Clinical and pathological characteristics of MPM patients treated by P/D between January 2013 and January 2020 were reviewed. Overall 30- and 90-day mortality and 1- and 2-year survival rates were calculated. Univariate and regression analyses of factors related to long-term survival were performed. Kaplan-Meier curves and the long-rank test were used to analyse differences between induction and adjuvant chemotherapy.

Results: A total of 41 patients (31 male and 9 female) with a mean age of 65±7.8 years underwent P/D for MPM. The 30- and 90-day mortality rates were 2.5% and 5.4%, respectively. Overall 1-, and 2-year survival (OS) rates were 67.6% and 41.4%, respectively. Progressive disease occurred in 63.2% of all patients. Multiple regression analysis revealed age>70 years, asbestos exposure, T-status, N-status, tumour pathology, (neo)adjuvant therapy, postoperative morbidity, and progressive disease as significant prognostic factors (p<0.05). Prognosis was significantly better in the induction chemotherapy group compared to the adjuvant chemotherapy group (p=0.03).

Conclusion: Patients treated with P/D for MPM in a multimodal setting have acceptable overall survival rates. The findings suggest that induction chemotherapy results in better OS than adjuvant chemotherapy.