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

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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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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Keywords

  • Pleurectomy
  • Decortication
  • Extrapleural pneumonectomy
  • Malignant pleural mesothelioma