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The role of video assisted thoracoscopic pleurectomy/decortication in the therapeutic management of malignant pleural mesothelioma

Department of Thoracic Surgery, Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom

Received 12 June 2007; received in revised form 12 September 2007; accepted 26 September 2007.

^_* Corresponding author. Tel.: +44 116 2563959; fax: +44 116 2563139. (Email: david.waller{at}uhl-tr.nhs.uk).

Objective: Extrapleural pneumonectomy (EPP) has high mortality and morbidity; radical pleurectomy decortication (P/D) carries less mortality but still significant morbidity. This surgery is not suitable for many patients with malignant pleural mesothelioma (MPM) for whom video assisted thoracic surgery (VATS) offers a minimally invasive alternative. We aimed to assess the role of VATS decortication for MPM. Methods: Over a 9-year period 208 patients underwent therapeutic surgery for MPM in our unit. One hundred and twelve of the patients underwent EPP, 29 had a P/D and 67 had VATS decortication. Sixty-three of the 208 patients (EPP n = 13, P/D n = 8 and VATS decortication n = 42) were 65 years of age or older at the time of the operation (57 males and 6 females, age 70 (65–80) years). In this group we analyzed perioperative morbidity and mortality and long-term survival data using the Kaplan–Meier method. Results: Postoperative stay and 30-day mortality was significantly lower for VATS P/D than for EPP (14.3 days vs 36.6 days, p < 0.05 and mortality 7.1% vs 23%, respectively). There was no significant difference in the overall mean survival between the two groups (11.5 months for EPP and 14 months for VATS P/D, p = 0.6). Conclusion: VATS decortication should be considered in the therapeutic strategy for MPM.

Key Words: Mesothelioma • Surgery • Pleuropneumonectomy • Decortication • Pleurectomy

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