Systematic review of pleurectomy in the treatment of malignant pleural mesothelioma

Our plain-English summary of Systematic review of pleurectomy in the treatment of malignant pleural mesothelioma, by C. Cao, D.H. Tian, K.A. Pataky, et al (Lung Cancer, 2013).

The study

• Authors: C. Cao, D.H. Tian, K.A. Pataky, T.D. Yan
• Journal: Lung Cancer
• Published: 2013;81(3):319-327
• Type of article: Meta-analysis, Systematic review
• Cited by: 42 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Pleurectomy/decortication (P/D) in the treatment of malignant pleural mesothelioma includes a number of procedures with different clinical indications and therapeutic intents. To unify the nomenclature, IMIG and IASLC recently defined P/D-related procedures according to surgical technique, including 'extended P/D', 'P/D' and 'partial pleurectomy'. The present systematic review aimed to assess the safety and efficacy of these techniques.

Methods: A systematic review of relevant studies was performed by electronic search of five online databases from 1985 to 2012 by two independent reviewers according to predefined selection criteria.

Results: Thirty-four studies involving 1916 patients who underwent pleurectomy were included for quantitative analysis. These included 12 studies on 'extended P/D', 8 studies on 'P/D' and 14 studies on 'partial pleurectomy'. Perioperative mortality ranged from 0% to 11% and perioperative morbidity ranged from 13% to 43%. Median overall survival ranged from 7.1 to 31.7 months and disease-free survival ranged from 6 to 16 months. One study reported on quality-of-life outcomes using a standardized questionnaire suggesting superior outcomes for 'extended P/D' compared to extrapleural pneumonectomy.

Conclusions: Results of the present systematic review suggested similar perioperative mortality outcomes between different P/D techniques but a trend towards higher morbidity and length of hospitalization for patients who underwent 'extended P/D'. However, overall and disease-free survival appeared to favour 'extended P/D' compared to less aggressive techniques. Future studies on P/D should adhere to recent definitions to enable accurate analysis of similar procedures. Direct comparisons of pleurectomy to extrapleural pneumonectomy remain challenging, and should be restricted to 'extended P/D' procedures only.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

In plain English

This article was a systematic review of earlier published studies, not a new study of patients. The authors searched five online databases for studies from January 1985 to 1 November 2012 on pleurectomy, an operation for malignant pleural mesothelioma. They included 34 studies with 1935 patients (the abstract gives 1916). They sorted the studies into three types of operation using international definitions: extended pleurectomy/decortication (12 studies), pleurectomy/decortication (8) and partial pleurectomy (14). Deaths around the time of surgery ranged from 0% to 11% after extended pleurectomy/decortication, 0% to 7.1% after pleurectomy/decortication, and 0% to 7.8% after partial pleurectomy. Median overall survival in the studies ranged from 11.5 to 31.7 months, 8.3 to 26 months, and 7.1 to 14 months for those three groups. Detailed statistical analysis was not possible. The authors concluded that selected patients who had extended pleurectomy/decortication may survive longer than those who had less aggressive operations, but possibly with more complications and longer hospital stays. They noted that all included studies were non-randomized case series from specialized centres.

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: Systematic review of published studies (all non-randomized case series) on pleurectomy for malignant pleural mesothelioma
• Who was studied: 34 studies including 1935 patients with histopathologically proven malignant pleural mesothelioma (MPM) who underwent a pleurectomy-related procedure, from centres in Europe, North America, Japan, Australia, South Africa, Turkey and Canada (abstract states 1916 patients)
• Exposure: Surgical treatment, not asbestos exposure: pleurectomy procedures classed as extended pleurectomy/decortication (P/D), P/D, or partial pleurectomy, alone or with chemotherapy, radiotherapy or other therapies
• Main results:
  • Extended P/D: perioperative (30-day or in-hospital) mortality 0% to 11%; overall perioperative morbidity 20–43%; average hospital stay 7 to 15 days
  • P/D: perioperative mortality 0% to 7.1%; overall perioperative morbidity 13% to 48%; average hospital stay 7 to 14 days
  • Partial pleurectomy: perioperative mortality 0% to 7.8%; overall perioperative morbidity 14% to 20%; average hospital stay 6 to 11 days
  • Extended P/D: median overall survival across studies 11.5 to 31.7 months (middle two quartiles 15 to 25 months); median disease-free survival 7.2 to 16 months
  • P/D: median overall survival across studies 8.3 to 26 months (middle two quartiles 12 to 18 months); median disease-free survival 6 to 7.4 months
  • Partial pleurectomy: median overall survival across studies 7.1 to 14 months (middle two quartiles 9 to 13 months); disease-free survival reported in only one study, median 10 months
  • Without detailed statistical analysis, median overall and disease-free survival appeared longer after extended P/D than after P/D and partial pleurectomy
  • In the only included study that used a standardized quality-of-life questionnaire, a small group, quality of life after extended P/D appeared better at 6 and 12 months than after extrapleural pneumonectomy (EPP)
• The authors' conclusion: The authors concluded that selected patients who undergo extended P/D may achieve longer overall and disease-free survival than those who undergo less aggressive procedures (P/D or partial pleurectomy), possibly with higher morbidity and longer hospitalization
• Limitations the authors state:
  • All included studies were non-randomized case series of selected patients treated in specialized centres
  • Results may not apply to all patients with MPM and should be interpreted with caution
  • Reporting differed greatly between institutions, including the start date used to calculate overall survival
  • Differences in adjuvant therapy and follow-up made disease-free survival and recurrence location hard to interpret
  • The surgical technique in each study had to be assumed from the descriptions provided

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: Systematic Review, Pleural Mesothelioma, Pleurectomy/Decortication (P/D), IMIG, IASLC, Median Overall Survival, Disease-Free Survival, Extrapleural Pneumonectomy (EPP).

Related studies

• A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma — C. Cao, D. Tian, et al. (2014)
• Quality of life after radical pleurectomy decortication for malignant pleural mesothelioma — N.M. Mollberg, Y. Vigneswaran, et al. (2012)
• Surgery as part of radical treatment for malignant pleural mesothelioma — D.A. Waller, S. Tenconi (2017)
• 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)
• Radical pleurectomy and intraoperative photodynamic therapy for malignant pleural mesothelioma — J.S. Friedberg, M.J. Culligan, et al. (2012)

Browse more research in Lung Cancer, or return to medical research.