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Updated meta-analysis of survival after extrapleural pneumonectomy versus pleurectomy/decortication in mesothelioma

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Abstract

Objective

We reviewed the available literature on patients with MPM undergoing either extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D).

Methods

Original research studies that evaluated long-term outcomes of P/D versus EPP were identified, from January 1990 to July 2018. The 30 and 90 days mortality, along with the 1-, 2-, 3-, 5-year survival, the median overall survival and the complications were calculated according to both a fixed and a random effect model. The Q statistics and I2 statistic were used to test for heterogeneity among the studies.

Results

Fifteen studies were included, incorporating a total of 1672 patients treated with EPP and 2236 treated with P/D. The 30-day mortality was significantly higher in the EPP group [OR 3.24 (95% CI 1.70, 6.20); p < 0.001]. The median overall survival was significantly increased in the P/D group [WMD − 4.20 (− 5.66, − 2.74); p < 0.001]. No significant differences were found regarding the 90-day mortality and the 1-, 2-, 3-, 5-year survival between the EPP and P/D groups. The incidence of postoperative atrial fibrillation, hemorrhage, empyema, bronchopleural fistula and air leak was significantly increased in the EPP group (p < 0.05).

Conclusions

The present meta-analysis indicates that P/D is associated with enhanced outcomes regarding 30-day mortality, median overall survival, and complications. The P/D approach, should, therefore be preferred when technically feasible. However, the decision regarding the procedure of choice should be made on the basis of the disease status and the surgeon’s experience. Well-designed, randomized studies, comparing EPP to P/D, are necessary to further assess their clinical outcomes.

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Authors and Affiliations

  1. Department of Surgery, University Hospital of Larissa, Biopolis, 41110, Larissa, Greece

    Dimitrios E. Magouliotis

  2. Department of Pharmacology, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece

    Dimitrios E. Magouliotis

  3. Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece

    Vasiliki S. Tasiopoulou

  4. Unit of Thoracic Surgery, Evangelismos Hospital, Athens, Greece

    Kalliopi Athanassiadi

Authors
  1. Dimitrios E. Magouliotis
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  2. Vasiliki S. Tasiopoulou
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  3. Kalliopi Athanassiadi
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Correspondence to Dimitrios E. Magouliotis.

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Magouliotis, D.E., Tasiopoulou, V.S. & Athanassiadi, K. Updated meta-analysis of survival after extrapleural pneumonectomy versus pleurectomy/decortication in mesothelioma. Gen Thorac Cardiovasc Surg 67, 312–320 (2019). https://doi.org/10.1007/s11748-018-1027-6

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  • DOI: https://doi.org/10.1007/s11748-018-1027-6

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