Original article
General thoracic
Extended Pleurectomy and Decortication for Malignant Pleural Mesothelioma Is an Effective and Safe Cytoreductive Surgery in the Elderly

Presented at the Fortieth Annual Meeting of the Western Thoracic Surgical Association, Dana Point, CA, Jun 25–28, 2014.
https://doi.org/10.1016/j.athoracsur.2015.04.151Get rights and content

Background

A survival advantage has been observed among patients with malignant pleural mesothelioma undergoing maximal cytoreductive surgery and adjuvant therapy. Elderly patients are considered higher risk for these radical operations and are commonly not offered surgical treatment. We reviewed our experience with extended pleurectomy and decortication among patients 70 years or older and compared them with a cohort of younger patients undergoing extended pleurectomy and decortication for malignant pleural mesothelioma.

Methods

We performed a retrospective review of 117 consecutive patients undergoing extended pleurectomy and decortication at a university hospital from January 2008 to December 2013. Patients 70 years and older were compared with younger patients for postoperative outcome and survival. Survival was estimated using the Kaplan-Meier method.

Results

Fifty-four patients were 70 years or older; 63 were younger than 70 years. Older patients had more hypertension (71.2% versus 45.2%; p = 0.004) and coronary artery disease (22.6% versus 6.5%; p = 0.006). Major complications occurred in 3 patients (5.5%) in the older group and in 7 patients (11.1%) of the younger group (not significant). There were 2 deaths in each group after surgery (3.7% older versus 3.2% younger; not significant). Median survival was 15.6 months in the older patients and 14.0 months in the younger patients (not significant). Kaplan-Meier survival curves based on age groups were not significantly different with 1- and 2-year survivals of 64% versus 55% and 29% versus 32%, respectively.

Conclusions

Our study demonstrates that whereas age may be associated with more comorbid conditions in patients with malignant pleural mesothelioma undergoing extended pleurectomy and decortication, this does not necessarily translate into increased operative morbidity or mortality or shorter long-term survival.

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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