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

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Abstract

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.

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Acknowledgements

We thank each participant in the study, as well as all clinical staff and researchers who made the study possible.

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Authors and Affiliations

  1. Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan

    Masatoshi Kanayama, Masataka Mori, Hiroki Matsumiya, Akihiro Taira, Shinji Shinohara, Masaru Takenaka, Koji Kuroda & Fumihiro Tanaka

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  1. Masatoshi Kanayama
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  2. Masataka Mori
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  3. Hiroki Matsumiya
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  4. Akihiro Taira
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  5. Shinji Shinohara
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  6. Masaru Takenaka
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  7. Koji Kuroda
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  8. Fumihiro Tanaka
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Correspondence to Fumihiro Tanaka.

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Kanayama, M., Mori, M., Matsumiya, H. et al. Surgical strategy for malignant pleural mesothelioma: the superiority of pleurectomy/decortication. Surg Today 52, 1031–1038 (2022). https://doi.org/10.1007/s00595-021-02437-9

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  • DOI: https://doi.org/10.1007/s00595-021-02437-9

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