Mesothelioma: "Extrapleural pneumonectomy is associated with greater morbidity and mortality compared with pleurectomy/decortication..."

J Thorac Cardiovasc Surg. 2014 Mar 14. pii: S0022-5223(14)00318-3. doi: 10.1016/j.jtcvs.2014.03.011. [Epub ahead of print]

Malignant pleural mesothelioma and the Society of Thoracic Surgeons Database: An analysis of surgical morbidity and mortality.

Burt BM1, Cameron RB2, Mollberg NM3, Kosinski AS4, Schipper PH5, Shrager JB1, Vigneswaran WT6.

Author information

• 1Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif.
• 2Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA and West Los Angeles VA Medical Center, Los Angeles, Calif.
• 3Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash.
• 4Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC.
• 5Department of Cardiothoracic Surgery, Oregon Heath and Science University, Portland, Ore.
• 6Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago, Medicine and Biological Sciences, Chicago, Ill. Electronic address: wvignesw@surgery.bsd.uchicago.edu.

Abstract

BACKGROUND:

To date, reported surgical morbidity and mortality for pleurectomy/decortication and extrapleural pneumonectomy performed for malignant pleural mesothelioma primarily represent the experience of a few specialized centers. For comparison, we examined early outcomes of pleurectomy/decortication and extrapleural pneumonectomy from a broader group of centers/surgeons participating in the Society of Thoracic Surgeons-General Thoracic Database.

METHODS:

All patients in the Society of Thoracic Surgeons-General Thoracic Database (version 2.081, representing 2009-2011) who underwent pleurectomy/decortication or extrapleural pneumonectomy for malignant pleural mesothelioma were identified. Patient characteristics, morbidity, mortality, center volume, and procedure were examined using univariable and multivariable analyses.

RESULTS:

A total of 225 patients underwent pleurectomy/decortication (n = 130) or extrapleural pneumonectomy (n = 95) for malignant pleuralmesothelioma at 48 centers. Higher volumes of procedures (≥5/y) were performed at 3 pleurectomy/decortication and 2 extrapleural pneumonectomy centers. Patient characteristics were statistically equivalent between pleurectomy/decortication and extrapleural pneumonectomy groups, except those undergoing extrapleural pneumonectomy were younger (63.2 ± 7.8 years vs 68.3 ± 9.5 years; P < .001) and more likely to have received preoperative chemotherapy (30.1% vs 17.8%; P = .036). Major morbidity was greater after extrapleural pneumonectomy, including acute respiratory distress syndrome (8.4% vs 0.8%; P = .005), reintubation (14.7% vs 2.3%; P = .001), unexpected reoperation (9.5% vs 1.5%; P = .01), and sepsis (4.2% vs 0%; P = .03), as was mortality (10.5% vs 3.1%; P = .03). Multivariate analyses revealed that extrapleural pneumonectomy was an independent predictor of major morbidity or mortality (odds ratio, 6.51; P = .001). Compared with high-volume centers, increased acute respiratory distress syndrome was seen in low-volume centers performing extrapleural pneumonectomy (0% vs 12.5%; P = .05).

CONCLUSIONS:

Extrapleural pneumonectomy is associated with greater morbidity and mortality compared with pleurectomy/decortication when performed by participating surgeons of the Society of Thoracic Surgeons-General Thoracic Database. Effects of center volume require further study.