Short-term outcomes of pleurectomy decortication and extrapleural pneumonectomy in mesothelioma

Our plain-English summary of Short-term outcomes of pleurectomy decortication and extrapleural pneumonectomy in mesothelioma, by M. van Gerwen, A. Wolf, B. Liu, et al (Journal of Surgical Oncology, 2018).

The study

• Authors: M. van Gerwen, A. Wolf, B. Liu, R. Flores, E. Taioli
• Journal: Journal of Surgical Oncology
• Published: 2018;118(7):1178-1187
• Type of article: Meta-analysis, Review
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background/objectives: We evaluated postoperative mortality and complications after extrapleural pneumonectomy (EPP) and pleurectomy decortication (P/D) to better understand their effectiveness in malignant pleural mesothelioma (MPM).

Methods: A meta-analysis was done to evaluate 30-day mortality and postoperative complications. In addition, in-patients data of 500 eligible patients with MPM who underwent EPP or P/D was extracted from the New York Statewide Planning and Research Cooperative System (SPARCS). Multivariate analyses and propensity matching were used to compare in-hospital mortality and postoperative complications in EPP vs P/D.

Results: The meta-analysis showed a statistically significant difference in 30-day mortality (5% [95% CI: 4-6] vs P/D 2% [95% CI: 1-3]), proportion of complications (46% [95% CI: 36-56] vs 24% [95% CI: 15-34]) and postoperative arrhythmias (20% [95% CI: 12-31] vs 5% [95% CI: 2-8]) for EPP vs P/D. In-hospital mortality (OR adj : 2.6; 95% CI: 0.86-7.75) and postoperative complications (OR adj : 1.1; 95% CI: 0.68-1.86) were not different in EPP compared with P/D while supraventricular arrhythmia was significantly more frequent after EPP vs P/D (OR adj : 5.2; 95% CI: 2.34-11.33).

Conclusions: Postoperative mortality, postoperative complications, and particularly supraventricular arrhythmia are less frequent after P/D vs EPP. P/D, a less invasive surgery, may provide a better option when technically feasible for patients with MPM.

© 2018 Wiley Periodicals, Inc.

In plain English

This study compared short-term outcomes of two operations for malignant pleural mesothelioma: extrapleural pneumonectomy (EPP), which removes the lung, and pleurectomy decortication (P/D), which preserves it. The authors combined a meta-analysis of published observational studies with an analysis of New York State hospital records (SPARCS) for 500 patients (233 EPP, 267 P/D) in 76 hospitals. In the pooled studies, 30-day mortality was 5% (95% CI 4-6%) after EPP versus 2% (1-3%) after P/D, complications 46% (36-56%) versus 24% (15-34%), and supraventricular arrhythmia, an abnormal heart rhythm, 20% (12-31%) versus 5% (2-8%). All three differences were statistically significant. In the New York records, in-hospital death was higher after EPP, but the difference was not statistically significant (adjusted odds ratio 2.6; 95% CI 0.86-7.75). Overall complications were similar (1.1; 0.68-1.86). Supraventricular arrhythmia was significantly more frequent after EPP (5.2; 2.34-11.33). The authors concluded that P/D, a less invasive surgery, may be a better option when technically feasible. They noted that the hospital records lacked cancer stage and histology, which may have influenced the choice of surgery.

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: Meta-analysis of published observational studies, combined with a retrospective analysis of a New York State administrative hospital database (SPARCS)
• Who was studied: 500 patients with malignant pleural mesothelioma (MPM) in the SPARCS database, from admissions between 1995 and 2012, treated in 76 New York State hospitals: 233 had EPP and 267 had P/D. The meta-analysis drew on published studies found in PubMed from January 1990 to December 2017.
• Exposure: The study compared types of surgery: extrapleural pneumonectomy (EPP), which removes the lung together with the pleura, diaphragm and pericardium, versus radical pleurectomy decortication (P/D), which removes the same tissues but preserves the lung. Asbestos exposure was not studied.
• Main results:
  • The meta-analysis included 20 datasets on 30-day mortality and 19 datasets on postoperative complications.
  • Meta-analysis: pooled 30-day mortality was 5% (95% CI 4%-6%) after EPP and 2% (95% CI 1%-3%) after P/D. The difference was statistically significant.
  • Meta-analysis: the proportion with postoperative complications was 46% (95% CI 36%-56%) after EPP and 24% (95% CI 15%-34%) after P/D, a statistically significant difference. The studies varied a great deal (high heterogeneity).
  • Meta-analysis: supraventricular arrhythmia after surgery occurred in 20% (95% CI 12%-31%) of EPP patients and 5% (95% CI 2%-8%) of P/D patients, a statistically significant difference.
  • SPARCS, adjusted analysis: in-hospital mortality was higher for EPP than for P/D, but the difference was not statistically significant (adjusted OR 2.6; 95% CI 0.86-7.75).
  • SPARCS, adjusted analysis: postoperative complications were similar in the EPP and P/D groups (adjusted OR 1.1; 95% CI 0.68-1.86).
  • SPARCS, adjusted analysis: supraventricular arrhythmia was significantly more frequent after EPP than after P/D (adjusted OR 5.2; 95% CI 2.34-11.33). It remained so when patients who had extended or radical surgery were excluded (adjusted OR 4.7; 95% CI 1.97-11.12).
  • SPARCS, propensity-matched groups (93 EPP and 93 P/D): in-hospital mortality OR 2.82 (95% CI 0.70-11.38), not significant; postoperative complications OR 1.22 (95% CI 0.68-2.20); supraventricular arrhythmia significantly more frequent after EPP (OR 2.73; 95% CI 1.14-6.50).
  • SPARCS: compared with P/D patients, EPP patients were younger (mean age 60.8 vs 68.5 years), more often privately insured (56.2% vs 30.3%), and more often admitted for an elective procedure (98.3% vs 68.2%).
• The authors' conclusion: The authors concluded that the study suggests higher postoperative mortality and complication rates, especially arrhythmia, after EPP than after P/D. In their view, P/D, as the less invasive approach, may be a better option for patients with MPM when technically feasible.
• Limitations the authors state:
  • The administrative database lacked cancer stage and histology, which may have influenced the choice of surgery and introduced selection bias.
  • SPARCS had no information on medication, so the effect of antiarrhythmic drugs and the need to treat arrhythmia after surgery could not be assessed.
  • SPARCS had no long-term follow-up, so that part of the study was limited to in-hospital mortality and complications. It could not evaluate 30-day mortality or quality of life.
  • In the meta-analysis, the choice of surgery in each study may have depended on stage, histology, age or comorbidities, which could not be accounted for.
  • The meta-analysis was retrospective, and data not reported in the original publications, such as additional treatments, were unavailable.

Topics

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

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Mesothelioma, Pleural Mesothelioma, Meta-Analysis.

Related studies

• Extrapleural Pneumonectomy Versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma — N. Zhou, D.C. Rice, et al. (2022)
• Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma — E. Taioli, A.S. Wolf, et al. (2015)
• Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma — S. Hasegawa (2014)
• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)
• Extrapleural Pneumonectomy and Pleurectomy Decortication: Can We Really Compare Their Survival? — P. Bertoglio, S. Korasidis (2015)
• Pleurectomy/decortication is superior to extrapleural pneumonectomy in the multimodality management of patients with malignant pleural mesothelioma — L. Lang-Lazdunski, A. Bille, et al. (2012)

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