Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma

Our plain-English summary of Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma, by S. Hasegawa (General Thoracic and Cardiovascular Surgery, 2014).

The study

• Author: S. Hasegawa
• Journal: General Thoracic and Cardiovascular Surgery
• Published: 2014;62(9):516-21
• Type of article: Review
• Cited by: 31 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is associated with a very poor prognosis. Unlike other solid tumors, any type of planned surgery for MPM would be cytoreductive rather than radical. There are two types of surgery for MPM. Extrapleural pneumonectomy (EPP) involves en bloc resection of the lung, pleura, pericardium, and diaphragm. Pleurectomy/decortication (P/D) is a lung-sparing surgery that removes only parietal/visceral pleura. In comparison with EPP, P/D is theoretically less radical but is associated with less perioperative mortality/morbidity and less postoperative deterioration of cardiopulmonary function. It still remains unclear which surgical technique is superior in terms of the risk/benefit ratio. In this context, selection between EPP and P/D has been a matter to debate.

In plain English

This invited review article came from the Department of Thoracic Surgery at Hyogo College of Medicine in Japan. It discussed the choice between two operations for malignant pleural mesothelioma. Extrapleural pneumonectomy (EPP) removes the lung, pleura, pericardium and diaphragm together. Pleurectomy/decortication (P/D) spares the lung and removes the pleura. The article reported no new patient data and did not study asbestos exposure. The author described P/D as theoretically less radical, but noted that most hospitals had reported equal or better survival after P/D. The author cited a meta-analysis by Cao et al. that found lower perioperative mortality (2.9 vs. 6.8 %) and morbidity (27.9 vs. 62.0 %) after extended P/D than after EPP. The author pointed out that no randomized study had compared the two operations and that European guidelines called the role of surgery very uncertain. The author proposed a revised definition of P/D. The author also described the Hyogo approach: surgery started with the intention of performing P/D, except in some cases with extensive invasion into lung tissue. The author concluded it remained unclear which technique was superior.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: narrative review article (invited); no new patient data
• Who was studied: Published studies, guidelines and consensus reports on surgery for malignant pleural mesothelioma, plus a description of the current surgical approach at Hyogo College of Medicine, Japan
• Main results:
  • The author reported that most hospitals had found equal or better survival after P/D than after EPP (results of other studies, not this article).
  • In a systematic analysis by Cao et al. cited by the author, patients who underwent extended P/D had significantly lower perioperative mortality than those who underwent EPP (2.9 vs. 6.8 %, p = 0.02). They also had significantly lower morbidity (27.9 vs. 62.0 %, p less than 0.0001).
  • In a study by Bolukbas et al. cited by the author, additional chemotherapy after recurrence was acceptable in 64 % of patients who initially underwent P/D and 25 % of those who initially underwent EPP.
  • The author noted that European guidelines (ERS/ESTS and BTS) state that the role of surgical resection in malignant pleural mesothelioma is very uncertain.
  • The author proposed redefining P/D as parietal and visceral pleurectomy to remove all gross tumor, with resection of the diaphragm and/or pericardium if required.
  • At Hyogo College of Medicine, surgery was begun with the intention of performing P/D, except in some cases with extensive invasion of the tumor into the lung tissue.
• The authors' conclusion: The author concluded that, because no randomized study has compared EPP and P/D, it remains unclear whether survival after P/D is really equal to or better than after EPP, and which technique is superior.
• Limitations the authors state:
  • The author noted that the studies comparing the operations were not prospective and may reflect patient selection bias, and that no randomized comparison of EPP and P/D exists.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D), Pleural Mesothelioma, Prognosis, Cytoreductive Surgery, Pleura, Pericardium, Diaphragm.

Related studies

• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)
• Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma — E. Taioli, A.S. Wolf, et al. (2015)
• Extrapleural Pneumonectomy Versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma — N. Zhou, D.C. Rice, et al. (2022)
• Short-term outcomes of pleurectomy decortication and extrapleural pneumonectomy in mesothelioma — M. van Gerwen, A. Wolf, et al. (2018)
• Extrapleural Pneumonectomy and Pleurectomy Decortication: Can We Really Compare Their Survival? — P. Bertoglio, S. Korasidis (2015)
• Interim results of pleurectomy/decortication and intraoperative intrapleural hyperthermic cisplatin perfusion for patients with malignant pleural mesothelioma intolerable to extrapleural pneumonectomy — H. Ishibashi, M. Kobayashi, et al. (2015)

Browse more research in General Thoracic and Cardiovascular Surgery, or return to medical research.