Original articleGeneral thoracicExtended Pleurectomy and Decortication for Malignant Pleural Mesothelioma Is an Effective and Safe Cytoreductive Surgery in the Elderly
Section snippets
Material and Methods
This was a retrospective review of all patients undergoing EPD for MPM at a single institution, by 1 surgeon (W.T.V.), from January 2008 to December 2013. All patients consented to participate in this institutional review board–approved study. Patients presenting with surgically resectable pleural mesothelioma were initially evaluated for histologic subtype and for extent of disease using chest computed tomography and positron emission tomography scans. If detailed histologic examination was
Results
We identified 117 patients who underwent EPD during the study period. There were 94 men (80.3%). The median age was 69 years. There were 54 patients 70 years and older (range, 70 to 88 years) and 63 patients younger than 70 years (range, 43 to 69.9 years). The older patient group had more hypertension and coronary artery disease (Table 1). In the older group, only 1 patient had a history of cerebrovascular disease, 1 had a history of peripheral vascular disease, and 2 had a history of
Comment
The most effective treatment approach for MPM is controversial. A recent meta-analysis of seven surgical studies supports EPD over EPP because it provides a greater than 50% reduction in postoperative morbidity and mortality with an equivalent, if not greater, median overall survival [5]. When analyzing these reviews, however, the biases that go into selecting a patient for one or the other procedure have to be considered.
There are limited randomized data on operative intervention for MPM. The
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