title: A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma.
abstract: BACKGROUND
  Malignant pleural mesothelioma (MPM) is an aggressive disease of the pleural lining with a dismal prognosis. Surgical treatments of MPM with a curative intent include extrapleural pneumonectomy and extended pleurectomy/decortication (P/D). This meta-analysis aimed to compare the perioperative and long-term outcomes of EPP and extended P/D for selected surgical candidates.
  
  
  METHODS
  A systematic review of the literature was performed on six electronic databases to identify all relevant data on comparative outcomes of extended P/D and EPP in a multimodality setting. Endpoints included perioperative mortality and morbidity, as well as long-term overall survival.
  
  
  RESULTS
  Seven relevant studies with comparative data on EPP (n=632) versus extended P/D (n=513) were identified from the current literature. Comparison of these two groups demonstrated significantly lower perioperative mortality (2.9% vs. 6.8%, p=0.02) and morbidity (27.9% vs. 62.0%, p<0.0001) for patients who underwent extended P/D compared to EPP. Median overall survival ranged between 13-29 months for extended P/D and 12-22 months for EPP, with a trend favouring extended P/D.
  
  
  CONCLUSIONS
  Although it must be emphasized that patient selection and treatment strategies differ between EPP and extended P/D, a number of comparative studies have recently been conducted to compare these two surgical techniques for patients with resectable MPM. The present study indicated that selected patients who underwent extended P/D had lower perioperative morbidity and mortality with similar, if not superior, long-term survival compared to EPP, in the context of multi-modality therapy. This may represent an important paradigm shift in the surgical management of MPM.
authors.affiliation: The Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, 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: The Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Tian
authors.affiliation: The Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Park
authors.affiliation: The Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Allan
authors.affiliation: The Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: Kristopher A
authors.initials: KA
authors.lastname: Pataky
authors.affiliation: The Systematic Review Unit, Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
mesh_terms: D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D008654:Mesothelioma / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D000086002:Mesothelioma, Malignant; D059035:Perioperative Period; D010994:Pleura / Q000601:surgery*; D010997:Pleural Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D011013:Pneumonectomy; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Mesothelioma; Meta-analysis; Pleurectomy; Pneumonectomy; Surgery; Systematic review