Extrapleural Pneumonectomy for Early Stage Malignant Pleural Mesothelioma: A Harmful Procedure

Lung Cancer. 2012 Jul;77(1):151-5. doi: 10.1016/j.lungcan.2011.12.009. Epub 2012 Jan 11.


The effects on long-term post-operative quality of life (QoL) and disease-control in malignant pleural mesothelioma (MPM) of extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are compared. Seventy-seven patients affected by early-stage MPM received EPP (40) or P/D (37) associated with multimodal treatment between 1998 and 2009 at our institution. The last consecutive 39 (19 EPP and 20 P/D) were asked to answer the EORTC-QLQ-C30 questionnaire at baseline and at 6- and 12-months after treatment completion to evaluate the impact on QoL of both procedures. QoL evaluation was stopped at recurrence demonstration. Twenty-five (62%) EPP vs 9 (24%) P/D patients (p = 0.002) had in-hospital major complications, and 2/40 (5%) EPP vs no one P/D patients died after surgery. Both procedures caused a significant impairment of all the considered variables of the EORTC-QLQ-C30 questionnaire after treatment completion; only P/D patients returned at baseline levels after 12 months. EPP patients had a worse long-term post-operative QoL when compared with P/D. Median post-operative disease-free period was longer for EPP patients (14 vs 11 months) whereas the residual life to death period after recurrence detection was significantly longer for P/D patients (13 vs 9 months) (p = 0.01). Median long-term survival was longer, even not significant, for P/D patients (25 vs 20 months). MPM patients submitted to EPP had a higher post-operative complication rate, a worse long-term QoL, a shorter residual life time after recurrent disease, despite a similar long-term survival when compared to P/D.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Diaphragm / surgery
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Mesothelioma / mortality
  • Mesothelioma / pathology
  • Mesothelioma / surgery*
  • Middle Aged
  • Neoplasm Recurrence, Local*
  • Pleura / surgery
  • Pleural Neoplasms / mortality
  • Pleural Neoplasms / pathology
  • Pleural Neoplasms / surgery*
  • Pneumonectomy / adverse effects*
  • Prospective Studies
  • Quality of Life
  • Surveys and Questionnaires
  • Treatment Outcome