Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: Results in 663 patients Journal Article
| Authors: | Flores, R. M.; Pass, H. I.; Seshan, V. E.; Dycoco, J.; Zakowski, M.; Carbone, M.; Bains, M. S.; Rusch, V. W. |
| Article Title: | Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: Results in 663 patients |
| Abstract: | Objective: The optimal procedure for resection of malignant pleural mesothelioma is controversial, partly because previous analyses include small numbers of patients. We performed a multi-institutional study to increase statistical power to detect significant differences in outcome between extrapleural pneumonectomy and pleurectomy/decortication. Methods: Patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy or pleurectomy/decortication at 3 institutions were identified. Survival and prognostic factors were analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis. Results: From 1990 to 2006, 663 consecutive patients (538 men and 125 women) underwent resection. The median age was 63 years (range, 26-93 years). The operative mortality was 7% for extrapleural pneumonectomy (n = 27/385) and 4% for pleurectomy/decortication (n = 13/278). Significant survival differences were seen for American Joint Committee on Cancer stages 1 to 4 (P < .001), epithelioid versus non-epithelioid histology (P < .001), extrapleural pneumonectomy versus pleurectomy/decortication (P < .001), multimodality therapy versus surgery alone (P < .001), and gender (P < .001). Multivariate analysis demonstrated a hazard rate of 1.4 for extrapleural pneumonectomy (P < .001) controlling for stage, histology, gender, and multimodality therapy. Conclusion: Patients who underwent pleurectomy/decortication had a better survival than those who underwent extrapleural pneumonectomy; however, the reasons are multifactorial and subject to selection bias. At present, the choice of resection should be tailored to the extent of disease, patient comorbidities, and type of multimodality therapy planned. © 2008 The American Association for Thoracic Surgery. |
| Keywords: | immunohistochemistry; adult; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; survival analysis; survival rate; retrospective studies; major clinical study; cancer staging; follow-up studies; neoplasm staging; cohort studies; lung resection; thoracotomy; pneumonectomy; proportional hazards models; risk assessment; kaplan-meiers estimate; proportional hazards model; pleura mesothelioma; mesothelioma; intermethod comparison; chi-square distribution; multivariate analysis; kaplan meier method; analysis of variance; pleurectomy; pleura; pleural neoplasms; log rank test; pleural cavity |
| Journal Title: | Journal of Thoracic and Cardiovascular Surgery |
| Volume: | 135 |
| Issue: | 3 |
| ISSN: | 0022-5223 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2008-03-01 |
| Start Page: | 620 |
| End Page: | 626.e3 |
| Language: | English |
| DOI: | 10.1016/j.jtcvs.2007.10.054 |
| PUBMED: | 18329481 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 93" - "Export Date: 17 November 2011" - "CODEN: JTCSA" - "Source: Scopus" |
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