A Systematic Review and Meta-Analysis of Surgical Treatments for Malignant Pleural Mesothelioma

Lung Cancer. 2014 Feb;83(2):240-5. doi: 10.1016/j.lungcan.2013.11.026. Epub 2013 Dec 6.

Abstract

Background: Malignant pleural mesothelioma (MPM) is an aggressive disease of the pleural lining with a dismal prognosis. Surgical treatments of MPM with a curative intent include extrapleural pneumonectomy and extended pleurectomy/decortication (P/D). This meta-analysis aimed to compare the perioperative and long-term outcomes of EPP and extended P/D for selected surgical candidates.

Methods: A systematic review of the literature was performed on six electronic databases to identify all relevant data on comparative outcomes of extended P/D and EPP in a multimodality setting. Endpoints included perioperative mortality and morbidity, as well as long-term overall survival.

Results: Seven relevant studies with comparative data on EPP (n=632) versus extended P/D (n=513) were identified from the current literature. Comparison of these two groups demonstrated significantly lower perioperative mortality (2.9% vs. 6.8%, p=0.02) and morbidity (27.9% vs. 62.0%, p<0.0001) for patients who underwent extended P/D compared to EPP. Median overall survival ranged between 13-29 months for extended P/D and 12-22 months for EPP, with a trend favouring extended P/D.

Conclusions: Although it must be emphasized that patient selection and treatment strategies differ between EPP and extended P/D, a number of comparative studies have recently been conducted to compare these two surgical techniques for patients with resectable MPM. The present study indicated that selected patients who underwent extended P/D had lower perioperative morbidity and mortality with similar, if not superior, long-term survival compared to EPP, in the context of multi-modality therapy. This may represent an important paradigm shift in the surgical management of MPM.

Keywords: Mesothelioma; Meta-analysis; Pleurectomy; Pneumonectomy; Surgery; Systematic review.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Clinical Trials as Topic
  • Combined Modality Therapy
  • Humans
  • Lung Neoplasms / mortality
  • Lung Neoplasms / surgery*
  • Lung Neoplasms / therapy
  • Mesothelioma / mortality
  • Mesothelioma / surgery*
  • Mesothelioma / therapy
  • Perioperative Period
  • Pleura / surgery*
  • Pleural Neoplasms / mortality
  • Pleural Neoplasms / surgery*
  • Pleural Neoplasms / therapy
  • Pneumonectomy*
  • Survival Analysis
  • Time Factors
  • Treatment Outcome

Supplementary concepts

  • Mesothelioma, Malignant