The role of video assisted thoracoscopic pleurectomy/decortication in the therapeutic management of malignant pleural mesothelioma

Eur J Cardiothorac Surg. 2008 Jan;33(1):83-8. doi: 10.1016/j.ejcts.2007.09.039. Epub 2007 Nov 28.


Objective: Extrapleural pneumonectomy (EPP) has high mortality and morbidity; radical pleurectomy decortication (P/D) carries less mortality but still significant morbidity. This surgery is not suitable for many patients with malignant pleural mesothelioma (MPM) for whom video assisted thoracic surgery (VATS) offers a minimally invasive alternative. We aimed to assess the role of VATS decortication for MPM.

Methods: Over a 9-year period 208 patients underwent therapeutic surgery for MPM in our unit. One hundred and twelve of the patients underwent EPP, 29 had a P/D and 67 had VATS decortication. Sixty-three of the 208 patients (EPP n=13, P/D n=8 and VATS decortication n=42) were 65 years of age or older at the time of the operation (57 males and 6 females, age 70 (65-80) years). In this group we analyzed perioperative morbidity and mortality and long-term survival data using the Kaplan-Meier method.

Results: Postoperative stay and 30-day mortality was significantly lower for VATS P/D than for EPP (14.3 days vs 36.6 days, p<0.05 and mortality 7.1% vs 23%, respectively). There was no significant difference in the overall mean survival between the two groups (11.5 months for EPP and 14 months for VATS P/D, p=0.6).

Conclusion: VATS decortication should be considered in the therapeutic strategy for MPM.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cause of Death
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Mesothelioma / mortality
  • Mesothelioma / surgery*
  • Pleural Neoplasms / mortality
  • Pleural Neoplasms / surgery*
  • Pneumonectomy / methods*
  • Thoracic Surgery, Video-Assisted / methods
  • Thoracic Surgery, Video-Assisted / standards*
  • Treatment Outcome