title: Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients.
abstract: OBJECTIVE
  The optimal procedure for resection of malignant pleural mesothelioma is controversial, partly because previous analyses include small numbers of patients. We performed a multi-institutional study to increase statistical power to detect significant differences in outcome between extrapleural pneumonectomy and pleurectomy/decortication.
  
  
  METHODS
  Patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy or pleurectomy/decortication at 3 institutions were identified. Survival and prognostic factors were analyzed by the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis.
  
  
  RESULTS
  From 1990 to 2006, 663 consecutive patients (538 men and 125 women) underwent resection. The median age was 63 years (range, 26-93 years). The operative mortality was 7% for extrapleural pneumonectomy (n = 27/385) and 4% for pleurectomy/decortication (n = 13/278). Significant survival differences were seen for American Joint Committee on Cancer stages 1 to 4 (P < .001), epithelioid versus non-epithelioid histology (P < .001), extrapleural pneumonectomy versus pleurectomy/decortication (P < .001), multimodality therapy versus surgery alone (P < .001), and gender (P < .001). Multivariate analysis demonstrated a hazard rate of 1.4 for extrapleural pneumonectomy (P < .001) controlling for stage, histology, gender, and multimodality therapy.
  
  
  CONCLUSIONS
  Patients who underwent pleurectomy/decortication had a better survival than those who underwent extrapleural pneumonectomy; however, the reasons are multifactorial and subject to selection bias. At present, the choice of resection should be tailored to the extent of disease, patient comorbidities, and type of multimodality therapy planned.
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. floresr@mskcc.org
authors.forename: Raja M
authors.initials: RM
authors.lastname: Flores
authors.forename: Harvey I
authors.initials: HI
authors.lastname: Pass
authors.forename: Venkatraman E
authors.initials: VE
authors.lastname: Seshan
authors.forename: Joseph
authors.initials: J
authors.lastname: Dycoco
authors.forename: Maureen
authors.initials: M
authors.lastname: Zakowski
authors.forename: Michele
authors.initials: M
authors.lastname: Carbone
authors.forename: Manjit S
authors.initials: MS
authors.lastname: Bains
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008654:Mesothelioma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D010994:Pleura / Q000601:surgery*; D035422:Pleural Cavity; D010997:Pleural Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome