Japanese Current Status of Curative-Intent Surgery for Malignant Pleural Mesothelioma

Our plain-English summary of Japanese Current Status of Curative-Intent Surgery for Malignant Pleural Mesothelioma, by M. Hashimoto, H. Yamamoto, S. Endo, et al (The Annals of Thoracic Surgery, 2022).

The study

• Authors: M. Hashimoto, H. Yamamoto, S. Endo, M. Okada, H. Miyata, S. Hasegawa, M. Chida
• Journal: The Annals of Thoracic Surgery
• Published: 2022;113(4):1348-1353
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Few reports about surgical outcomes in malignant pleural mesothelioma (MPM) have been based on reliable nationwide databases. Here, we analyzed the incidence, surgical outcome, and operative risk factors using Japanese nationwide database.

Methods: Characteristics and perioperative data from 622 patients who underwent curative-intent surgery for MPM between January 2014 and December 2017 were recorded from National Clinical Database of Japan. We analyzed the incidence, surgical outcomes, and risk factors for surgical complications after 2 surgical procedures (extrapleural pneumonectomy [EPP] and pleurectomy/decortication [P/D]).

Results: During 4 years, EPP was performed in 279 patients and P/D in 343. EPP was more frequently performed in institutions less experienced in MPM, while P/D was more frequently performed in institutions well experienced in MPM (P < .001), especially in high-volume centers with more than 10 cases during this period. P/D was more frequently performed, especially in high-volume centers. The morbidity rates were 45.2% in EPP and 35.9% in P/D. Heart failure and pneumonia were most frequent in EPP, while prolonged air leakage was most frequent in P/D. Thirty-day and in-hospital mortality rates were 1.1% and 3.2% (EPP) and 1.2% and 3.2% (P/D), respectively. Regression analyses revealed that higher age (>65 years) was associated with operative complications in EPP (odds ratio, 3.56 [95% confidence interval, 1.26-8.56]), whereas no risk factor was observed in P/D.

Conclusions: In Japanese nationwide annual database, P/D was more frequently performed, especially in high-volume centers. Morbidity was higher in EPP than P/D; however, the mortality rates were quite low in Japan regardless surgical procedures.

Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This observational study used Japan's National Clinical Database to examine 622 patients who had surgery intended to cure malignant pleural mesothelioma at 246 institutions between January 2014 and December 2017. It compared two operations: extrapleural pneumonectomy (EPP), performed in 279 patients, and pleurectomy/decortication (P/D), performed in 343. The article did not report the patients' asbestos exposure. P/D was performed significantly more often at institutions with 10 or more cases over the four years. Complications occurred in 45.2% of EPP patients and 35.9% of P/D patients. Death within 30 days was 1.1% after EPP and 1.2% after P/D, and in-hospital death was 3.2% after each. The most common complications were heart failure (7.5%) and pneumonia (7.2%) after EPP, and prolonged air leakage (22.4%) after P/D. For EPP, age over 65 was associated with complications (confidence interval 1.26 to 8.56). The text gives this odds ratio as 3.56, but the table gives 3.26. No risk factor was found for P/D. The authors noted that the study was retrospective, used only univariate analysis, and lacked tumor details and long-term survival data.

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: Observational cohort study using a nationwide surgical database; the authors describe it as retrospective
• Who was studied: 622 patients who underwent curative-intent surgery for malignant pleural mesothelioma (MPM) at 246 institutions in Japan, registered in the National Clinical Database between January 2014 and December 2017; emergency operations excluded; median age 66, 87.6% men
• Exposure: Type of surgery: extrapleural pneumonectomy (EPP, 279 patients) versus pleurectomy/decortication (P/D, 343 patients). Asbestos exposure is not reported.
• Main results:
  • P/D was performed significantly more often in well-experienced institutions (10 or more cases in 4 years) and EPP more often in less-experienced institutions (1 or 2 cases in 4 years), P < .001
  • Morbidity rate was 45.2% (126/279) in EPP and 35.9% (123/343) in P/D (P = .02 in Table 2)
  • 30-day mortality was 1.1% (3/279) in EPP and 1.2% (4/343) in P/D; in-hospital mortality was 3.2% in both (9/279 EPP, 11/343 P/D)
  • Most common complications: heart failure (7.5%) and pneumonia (7.2%) in EPP; prolonged air leakage (22.4%) in P/D
  • Intraoperative transfusion was more frequent in EPP than in P/D (57.0% vs. 46.9%)
  • Postoperative stay was significantly longer after EPP than after P/D (26 vs. 21 days, P<.001)
  • In EPP, age over 65 years was associated with operative complications in univariate analysis (OR 3.56 in text, 3.26 in Table 4; 95% CI 1.26 to 8.56)
  • In P/D, no baseline patient variable was associated with postoperative events
• The authors' conclusion: The authors concluded that, in the Japanese nationwide database, P/D was more often performed, especially in well-experienced institutions, that surgical mortality rates were quite low for both procedures, and that age over 65 was a risk factor in EPP
• Limitations the authors state:
  • Risk of bias from the retrospective design, with non-uniform patient characteristics and treatment strategies
  • Only univariate analysis of risk factors was possible because of too few events
  • The database lacks tumor status, pathology findings and MPM-specific complications
  • Long-term survival outcomes were not available

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D), High-Volume Center, Odds Ratio, confidence interval.

Related studies

• Treatment status and safety of crizotinib in 2028 Japanese patients with ALK-positive NSCLC in clinical settings — N. Ueno, S. Banno, et al. (2019)
• Long-term results of laparoscopic cytoreductive surgery and HIPEC for the curative treatment of low-grade pseudomyxoma peritonei and multicystic mesothelioma — F. Mercier, G. Jeremie, et al. (2020)
• Clinical Trials with Oncolytic Measles Virus: Current Status and Future Prospects — P. Msaouel, M. Opyrchal, et al. (2018)
• Raltitrexed: current clinical status and future directions — E. Van Cutsem, D. Cunningham, et al. (2002)
• Current status of screening for malignant pleural mesothelioma — H.I. Pass, M. Carbone (2009)
• Biomarkers for malignant pleural mesothelioma: current status — L. Greillier, P. Baas, et al. (2008)

Browse more research in The Annals of Thoracic Surgery, or return to medical research.