title: Systematic review of pleurectomy in the treatment of malignant pleural mesothelioma.
abstract: BACKGROUND
  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.
authors.affiliation: Collaborative Research (CORE) Group, Sydney, Australia; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia. Electronic address: drchriscao@gmail.com.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cao
authors.affiliation: Collaborative Research (CORE) Group, Sydney, Australia.
authors.forename: David H
authors.initials: DH
authors.lastname: Tian
authors.affiliation: Collaborative Research (CORE) Group, Sydney, Australia.
authors.forename: Kristopher A
authors.initials: KA
authors.lastname: Pataky
authors.affiliation: Collaborative Research (CORE) Group, Sydney, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008654:Mesothelioma / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D000086002:Mesothelioma, Malignant; D009367:Neoplasm Staging; D010994:Pleura / Q000473:pathology* / Q000601:surgery*; D010997:Pleural Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D011788:Quality of Life; D012008:Recurrence; D019616:Thoracic Surgical Procedures; D016896:Treatment Outcome
keywords: Mesothelioma; Pleurectomy; Systematic review