Does extrapleural pneumonectomy still have a role in the management of pleural mesothelioma?

J Thorac Cardiovasc Surg. 2014 Jan 15. pii: S0022-5223(14)00044-0. doi: 10.1016/j.jtcvs.2014.01.007. [Epub ahead of print]

Is there life after the Mesothelioma and Radical Surgery trial? Does extrapleural pneumonectomy still have a role in the management of pleural mesothelioma? A 13-year, single-center experience.

Qadri SS1, Cale A2, Loubani M2, Chaudhry MA2, Cowen ME2.

Author information

• 1Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, United Kingdom. Electronic address: ssaq98@yahoo.com.
• 2Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, United Kingdom.

Abstract

OBJECTIVES:

The Mesothelioma and Radical Surgery trial has shown no survival benefit for extrapleural pneumonectomy (EPP) in the treatment of malignant mesothelioma. We present our results and contrast it with the Mesothelioma and Radical Surgery trial results.

METHODS:

The data from patients who had undergone EPP for malignant mesothelioma from March 1999 to April 2011 were analyzed retrospectively, and patient survival was observed until February 2013. Risk was calculated using the Thoracic Surgery Scoring System.

RESULTS:

Thirty patients underwent EPP during this period. The mean age was 61 ± 9 years, with 29 men and 1 woman, and the mean Thoracic Surgery Scoring System was 7.9 ± 2.5. No in-hospital or 30-day mortality occurred. The overall median survival was 20 ± 24 months and increased to 47.5 ± 24 months for patients who completed trimodality treatment; 31% of patients survived ≥4 years and 2 were still alive at 6 and 7 years postoperatively. Survival was significantly longer for those with epithelioid versus biphasic mesothelioma, right versus left pneumonectomy, age < 65 years, and no stage N2 disease. Survival at 6, 12, and 18 months was 80%, 65%, and 55% versus 65%, 52%, and 34% in the Mesothelioma and Radical Surgery trial, respectively.

CONCLUSIONS:

Epithelioid mesothelioma, right pneumonectomy, negative extrapleural lymph nodes, and age < 65 years were associated with prolonged survival. Our results have shown that EPP has a role in the management of malignant mesothelioma in selected patients by experienced surgeons.