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Meta-analysis of survival after extrapleural pneumonectomy (EPP) versus pleurectomy/decortication (P/D) for malignant pleural mesothelioma in the context of macroscopic complete resection (MCR)

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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 1980 to February 2022. The 30-days and 90-day mortality, along with the 1-, 2-, 3-, 5-year survival, the median overall survival, the macroscopic complete resection (MCR) rate, and the complications were calculated according to both a fixed and a random effect model. The Q and I2 statistic were used to test for heterogeneity among the studies. Sensitivity analysis was performed including only studies that incorporated the MCR concept.

Results

Eighteen studies were included, incorporating a total of 4,852 patients treated with EPP and P/D. The 30-day mortality was significantly higher in the EPP group (OR: 2.79 [95% CI 1.30, 6.01]; p = 0.009). The median overall survival was higher in the P/D group (WMD:-4.55 [-6.05, -3.04]; p < 0.001). No differences were found regarding the 90-day mortality, MCR rate, and the 1-, 2-,3-, 5-year survival between the EPP and P/D groups. These findings were validated by the sensitivity analysis. The incidence of atrial fibrillation, hemorrhage, pulmonary embolism, air leak, and reoperation 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 be preferred when technically feasible. However, the procedure of choice should be decided based on the goal of MCR in the safest approach for the patient.

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Availability of material

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Funding

The participating authors declare no sources of financial reports that require acknowledgement.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece

    Dimitrios E. Magouliotis, Prokopis-Andreas Zotos, Despoina Koukousaki, Vasiliki Vasilaki, Ioustini Portesi & Kyriakos Spiliopoulos

  2. Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK

    Arian Arjomandi Rad

  3. Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, W2 1NY, UK

    Thanos Athanasiou

Authors
  1. Dimitrios E. Magouliotis
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Contributions

DEM contributed to the conception/design of the work, the acquisition, analysis, and interpretation of data, drafting, revising, and final approval of the manuscript. PAZ contributed to the design, acquisition, analysis, and interpretation of data, revising, and final approval of the manuscript. AAR contributed to the acquisition/analysis of data, drafting, revising, and final approval of the manuscript. DK contributed to the acquisition/analysis of data, drafting, revising, and final approval of the manuscript. VV and IP contributed to the design, the acquisition/analysis of data, drafting, revising, and final approval of the manuscript. KS contributed to the analysis of data, revising, and final approval of the manuscript. TA contributed to the conception/design of the work, the interpretation of data, drafting, revising, and final approval of the manuscript.

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Correspondence to Dimitrios E. Magouliotis.

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Magouliotis, D.E., Zotos, PA., Rad, A.A. et al. Meta-analysis of survival after extrapleural pneumonectomy (EPP) versus pleurectomy/decortication (P/D) for malignant pleural mesothelioma in the context of macroscopic complete resection (MCR). Updates Surg 74, 1827–1837 (2022). https://doi.org/10.1007/s13304-022-01369-4

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