Pleurectomy Decortication in the Treatment of Malignant Pleural Mesothelioma: Encouraging Results and Novel Prognostic Implications Based on Experience in 355 Consecutive Patients

Annals of Surgery 2020 December 3 [Link]

Moshe Lapidot, Ritu R Gill, Emanuele Mazzola, Samuel Freyaldenhoven, Scott J Swanson, Michael T Jaklitsch, David J Sugarbaker, Raphael Bueno


Objective: We report a series of 355 consecutive patients treated over 9 years in a single institution with intended PDC.

Background: Surgery for MPM has shifted from extra-pleural pneumonectomy to PDC with the goal of MCR.

Methods: Clinical and outcome data were reviewed. Kaplan-Meier estimators and log rank test were used to compare the overall survival, and logistic regression models were used.

Results: MCR was achieved in 304. There were 223 males, median age was 69 and histology was epithelioid in 184. The 30 and 90-day mortality were 3.0% and 4.6%.Most complications were low grade. Prolonged air leak in 141, deep venous thrombosis in 64, Atrial fibrillation in 42, chylothorax in 24, Empyema in 23, pneumonia in 21, Hemothorax in 12 and pulmonary embolus in 8.Median/5-year survival were 20.7 months/17.9% in the intent-to-treat cohort and 23.2 months/21.2% in the MCR group. The survivals were best for patients with T1stage and epithelioid histology (69.8 months/54.1%). In a multivariable analysis, factors that were found to be associated with longer patient overall survival included epithelioid histology, T stage, quantitative clinical stage/tumor volume staging, adjuvant chemotherapy, intraoperative heated chemo, female sex, and length of stay shorter than 14 days.

Conclusions: PDC is feasible with low mortality and is associated with manageable complication rates. 5-year survival of patients undergoing PDC with MCR in multi-modality setting is approaching 25% depending on quantitative and clinical stage, sex and histological subtype and is better than PDC without- MCR.