Surgical strategy for malignant pleural mesothelioma: the superiority of pleurectomy/decortication

Purpose Both extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are used for the surgical treatment of malignant pleural mesothelioma (MPM). This study aimed to compare the operative and clinical outcomes and survival between EPP and P/D. Methods We performed a retrospective analysis of the surgical and clinical data of 40 patients who underwent either EPP ( n = 18) or P/D ( n = 22) for MPM at our institution between January 2000 and December 2018. Results In comparison to EPP, P/D was associated with a higher intraoperative bleeding volume (1175 vs 1805 ml, p = 0.0020) and greater duration of postoperative thoracic drainage (3 vs 16 days, p < 0.0001). Adjuvant chemotherapy was more common after P/D (81.8%) than after EPP (33.3%; p = 0.0024). For epithelioid-type MPM, overall survival (OS) and recurrence-free survival (RFS) were significantly better in patients who underwent P/D in comparison to those who underwent EPP ( p = 0.040 and p = 0.015, respectively), with no difference for the biphasic and sarcomatoid types of MPM. A Cox proportional hazards regression model identified P/D as a significant favorable prognostic factor for OS [hazard ratio (HR), 0.391; 95% confidence interval (CI), 0.175–0.871; p = 0.022] and RFS (HR, 0.418; 95% CI, 0.190–0.920; p = 0.030). Conclusions Based on our findings, P/D may be superior to EPP for improving the prognosis of patients with resectable epithelioid-type MPM.