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


CONCLUSIONS
VATS decortication should be considered in the therapeutic strategy for MPM.
Department of Thoracic Surgery, Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom.
Apostolos
A
Nakas
Antonio E
AE
Martin Ucar
John G
JG
Edwards
David A
DA
Waller
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000601:surgery*; D010997:Pleural Neoplasms / Q000401:mortality / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods / Q000592:standards*; D016896:Treatment Outcome