O-072IS THERE ANY BENEFIT IN LUNG SPARING MACROSCOPIC COMPLETE RESECTION OVER VIDEO-ASSISTED DEBULKING IN MALIGNANT PLEURAL MESOTHELIOMA?

• Published in: Interactive cardiovascular and thoracic surgery 2013-07, Vol.17 (suppl_1), p.S19-S19
• Main Authors: Nakas, Apostolos, Tsitsias, T., Waller, D.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt288.72

Objectives The role of lung sparing surgery to prolong survival in the management of malignant pleural mesothelioma (MPM) is yet to be confirmed. Video-assisted debulking surgery (VATS PD) has a role in symptom control and may prolong survival. Our aim was to determine whether extended pleurectomy decortication (EPD) conveys any survival benefit over VATS PD. Methods From a prospective database we identified 236 patients (201 males) who underwent EPD (152 patients) and VATS PD (84 patients). The patients in the EPD group were younger (mean 62 years) than the VATS group (mean 67.4, P < 0.05). Cell type was similar (115 epithelioid and 37 biphasic in the EPD group, 70 epithelioid and 14 biphasic in the VATS PD group, P = 0.19). We tested for differences in survival using selected subgroups. Results Mean follow-up was 15.5 (1-93) months. Thirty- and 90-day mortality was similar: 4% for EPD vs 4.8% for VATS PD, P = 0.75 and 9.8 and 9.5%, P = 1, respectively. Overall survival was similar: median 14.4 months for EPD (SE 1.7, 95% CI 11-17.8) vs 13.2 for VATS PD (SE1, 95% CI 11.3-15.1), P = 0.26. From the EPD group a smaller subgroup of node-negative patients (n = 51) had better survival: median 16 (SE3, 95% CI 10-22.4, P = 0.038). In patients with epithelioid disease there was a trend for better survival with EPD (n = 115, median 18.2, SE 2, 95% CI 14.5-21.8) vs VATS (n = 70, median 14.4, SE 1, 95% CI 12-17, P = 0.14). In contrast the extent of surgery had no effect on survival in biphasic disease: EPD n = 37, median 9.7, (SE 1.5, 95% CI 6.7-12.7) vs VATS n = 14 (SE 2.5, 95% CI 3-13), P = 0.57. The smaller subgroup of epithelioid node negative EPD (n = 33) demonstrated the best survival (median 27, SE 9, 95% CI 9-44) compared to epithelioid VATS PD (n = 70, median 14.4, SE 1.2, 95% CI 12-17), P = 0.009. Conclusions Only node-negative patients with mesothelioma, especially epithelioid type, appear to benefit from radical surgery. This has many implications including accurate diagnosis of cell type and mediastinal staging. Disclosure All authors have declared no conflicts of interest.