Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma

Ann Thorac Surg. 2015 Feb;99(2):472-80. doi: 10.1016/j.athoracsur.2014.09.056. Epub 2014 Dec 20.


Background: This comprehensive meta-analysis was conducted to answer the question as to which procedure, pleurectomy decortication (P/D) or extrapleural pneumonectomy (EPP) is more beneficial to malignant pleural mesothelioma patients' outcome.

Methods: Original research studies that evaluated long-term outcomes of P/D versus EPP were identified, from January 1990 to January 2014. The combined percent perioperative and 2-year mortality, and median survival were calculated according to both a fixed and a random effect model. The Q statistics and I(2) statistic were used to test for heterogeneity between the studies.

Results: There were 24 distinct data sets, for a total of 1,512 patients treated with P/D, and 1,391 treated with EPP. There was a significantly higher proportion of short-term deaths in the EPP group versus the P/D group (percent mortality meta estimate; 4.5% vs 1.7%; p < 0.05). There was no statistically significant difference in 2-year mortality between the 2 groups, but there was significant heterogeneity.

Conclusions: The reanalysis of the large number of studies comparing P/D to EPP suggests that P/D is associated with a 2 ½-fold lower short-term mortality (perioperatively and within 30 days) than EPP. Pleurectomy decortication should therefore be preferred when technically feasible.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Humans
  • Mesothelioma / mortality*
  • Mesothelioma / surgery*
  • Pleura / surgery*
  • Pleural Neoplasms / mortality*
  • Pleural Neoplasms / surgery*
  • Pneumonectomy / methods*
  • Survival Rate
  • Time Factors