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Eur J Cardiothorac Surg 2007;31:765-770. doi:10.1016/j.ejcts.2007.01.064
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Case-control study between extrapleural pneumonectomy and radical pleurectomy/decortication for pathological N2 malignant pleural mesothelioma

Department of Thoracic Surgery, Glenfield Hospital, Leicester, United Kingdom

Received 19 September 2006; received in revised form 25 December 2006; accepted 15 January 2007.

^_* Corresponding author. Address: Department of Thoracic Surgery, University Hospitals Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom. Tel.: +44 116 256 3959; fax: +44 116 236 7768. (Email: david.waller{at}uhl-tr.nhs.uk).

Objective: To compare the outcomes of extrapleural pneumonectomy (EPP) and radical pleurectomy/decortication (P/D) for N2 malignant pleural mesothelioma (MM). Patients and methods: In a retrospective case-control study we analysed the results of the 57 patients [49 male and 8 female, median age 59 (range 14–70) years] who underwent radical surgery for MM found to have pathological N2 disease over a 7-year-period. EPP was performed on 45 and P/D on 12 patients. Prognostic factors, postoperative course, pathological data and postoperative survival were analysed. Results: Those in the P/D group were significantly older (median age 62 vs 58 years, p = 0.03) than in the EPP group. There was no difference in postoperative hospital stay (p = 0.1) nor T stage (p = 0.7) between the groups. There were no significant differences in the proportion of patients undergoing some adjuvant therapy in each group (p = 0.2). Mean survival from diagnosis was 15 months in the EPP group and 16 months for those who underwent P/D (p = 0.4). Conclusions: Preservation of the lung during radical surgery for N2 MM does not compromise survival even in an older group population. We therefore now have ceased to perform EPP in cases of N2 disease and we make every effort to accurately stage patients with mediastinoscopy to identify them.

Key Words: Malignant mesothelioma • Extrapleural pneumonectomy • Decortication • Pleurectomy

This article has been cited by other articles:

				C. Aigner, M. A. R. Hoda, G. Lang, S. Taghavi, G. Marta, and W. Klepetko Outcome after extrapleural pneumonectomy for malignant pleural mesothelioma. Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 204 - 207. [Abstract] [Full Text] [PDF]

				A. Nakas, A. E. Martin Ucar, J. G. Edwards, and D. A. Waller The role of video assisted thoracoscopic pleurectomy/decortication in the therapeutic management of malignant pleural mesothelioma Eur. J. Cardiothorac. Surg., January 1, 2008; 33(1): 83 - 88. [Abstract] [Full Text] [PDF]

				D. J. Sugarbaker Editorial comment Eur. J. Cardiothorac. Surg., May 1, 2007; 31(5): 770 - 771. [Full Text] [PDF]