A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma

• Published in: Lung cancer (Amsterdam, Netherlands) Netherlands), 2014-02, Vol.83 (2), p.240-245
• Main Authors: Cao, Christopher, Tian, David, Park, John, Allan, James, Pataky, Kristopher A, Yan, Tristan D
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Clinical Trials as Topic; Combined Modality Therapy; Hematology, Oncology and Palliative Medicine; Humans; Lung Neoplasms - mortality; Lung Neoplasms - surgery; Lung Neoplasms - therapy; Medical sciences; Mesothelioma; Mesothelioma - mortality; Mesothelioma - surgery; Mesothelioma - therapy; Mesothelioma, Malignant; Meta-analysis; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Perioperative Period; Pleura - surgery; Pleural Neoplasms - mortality; Pleural Neoplasms - surgery; Pleural Neoplasms - therapy; Pleurectomy; Pneumology; Pneumonectomy; Pulmonary/Respiratory; Surgery; Survival Analysis; Systematic review; Time Factors; Treatment Outcome; Tumors; Tumors of the respiratory system and mediastinum
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2013.11.026

Abstract Background Malignant pleural mesothelioma (MPM) is an aggressive disease of the pleural lining with a dismal prognosis. Surgical treatments of MPM with a curative intent include extrapleural pneumonectomy and extended pleurectomy/decortication (P/D). This meta-analysis aimed to compare the perioperative and long-term outcomes of EPP and extended P/D for selected surgical candidates. Methods A systematic review of the literature was performed on six electronic databases to identify all relevant data on comparative outcomes of extended P/D and EPP in a multimodality setting. Endpoints included perioperative mortality and morbidity, as well as long-term overall survival. Results Seven relevant studies with comparative data on EPP ( n = 632) versus extended P/D ( n = 513) were identified from the current literature. Comparison of these two groups demonstrated significantly lower perioperative mortality (2.9% vs 6.8%, p = 0.02) and morbidity (27.9% vs 62.0%, p < 0.0001) for patients who underwent extended P/D compared to EPP. Median overall survival ranged between 13–29 months for extended P/D and 12–22 months for EPP, with a trend favouring extended P/D. Conclusions Although it must be emphasized that patient selection and treatment strategies differ between EPP and extended P/D, a number of comparative studies have recently been conducted to compare these two surgical techniques for patients with resectable MPM. The present study indicated that selected patients who underwent extended P/D had lower perioperative morbidity and mortality with similar, if not superior, long-term survival compared to EPP, in the context of multi-modality therapy. This may represent an important paradigm shift in the surgical management of MPM.