title: Which type of surgery should become the preferred procedure for malignant pleural mesothelioma: extrapleural pneumonectomy or extended pleurectomy?
abstract: OBJECTIVE
  Since radiation and chemotherapy have limitations as therapies for malignant pleural mesothelioma (MPM). The type of surgery [extrapleural pneumonectomy (EPP), extended pleurectomy (E/P), and pleurectomy/decortication (P/D)] remains controversial.
  
  
  METHODS
  This study involves 76 consecutive patients. 58 of the cases were males (76%) with a median age of 53.17±10.93 years. EPP, E/P, and P/D were performed in 31, 20, and 25 cases, respectively.
  
  
  RESULTS
  The median survival time was 20 months in all patients. Overall, five-year survival rate was 14.3%. The survival rate was significantly better in epithelioid mesothelioma (P=0.049). For EPP cases, the median survival rate was 17 months, and the three-to-five year survival rates were 21% and 17%, respectively. For E/P cases, the median survival rate was 27 months and the three-year and four-year survival rates were 34% and 30%, respectively. For P/D cases, the median survival rate was 15 months and the three-to-five year survival rate was 13% and 0%. There were no statistically significant differences between the three surgical techniques (P=0.088). A comparative analysis indicates only a statistically significant difference in the E/P and P/D comparison (P=0.032). Hospital mortality showed a higher trend in EPP group (EPP: 12.9%, E/P: 0% and P/D: 4%, P=0.145). N2 cases, there were no cases of two-year survival. The survival rate in N2 was comparatively much lower, which was statistically significant (P=0.005). In multivariate analysis, only P/D (OR 0.3, 95% CI: 0.1-0.9, P=0.049) and N2 (OR 1.6, 95% CI: 0.9-2.6, P=0.090) were found to be poor prognostic factors.
  
  
  CONCLUSIONS
  E/P could be encouraged to EPP with lower mortality rate and better survival trend in MPM. N2 diseases were negative prognostic factors in MPM.
authors.affiliation: Department of Surgery, Yedikule Hospital for Chest Disease, Istanbul, Turkey;
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Bedirhan
authors.forename: Levent
authors.initials: L
authors.lastname: Cansever
authors.forename: Adalet
authors.initials: A
authors.lastname: Demir
authors.forename: Süleyman
authors.initials: S
authors.lastname: Ceyhan
authors.forename: Hasan
authors.initials: H
authors.lastname: Akın
authors.forename: Halide Nur
authors.initials: HN
authors.lastname: Urer
authors.forename: Aysun
authors.initials: A
authors.lastname: Olçmen
authors.forename: Celalettin
authors.initials: C
authors.lastname: Kocatürk
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Dinçer
keywords: Malignant pleural mesothelioma (MPM); multimodal therapy