title: Extended Pleurectomy and Decortication for Malignant Pleural Mesothelioma Is an Effective and Safe Cytoreductive Surgery in the Elderly.
abstract: BACKGROUND
  A survival advantage has been observed among patients with malignant pleural mesothelioma undergoing maximal cytoreductive surgery and adjuvant therapy. Elderly patients are considered higher risk for these radical operations and are commonly not offered surgical treatment. We reviewed our experience with extended pleurectomy and decortication among patients 70 years or older and compared them with a cohort of younger patients undergoing extended pleurectomy and decortication for malignant pleural mesothelioma.
  
  
  METHODS
  We performed a retrospective review of 117 consecutive patients undergoing extended pleurectomy and decortication at a university hospital from January 2008 to December 2013. Patients 70 years and older were compared with younger patients for postoperative outcome and survival. Survival was estimated using the Kaplan-Meier method.
  
  
  RESULTS
  Fifty-four patients were 70 years or older; 63 were younger than 70 years. Older patients had more hypertension (71.2% versus 45.2%; p = 0.004) and coronary artery disease (22.6% versus 6.5%; p = 0.006). Major complications occurred in 3 patients (5.5%) in the older group and in 7 patients (11.1%) of the younger group (not significant). There were 2 deaths in each group after surgery (3.7% older versus 3.2% younger; not significant). Median survival was 15.6 months in the older patients and 14.0 months in the younger patients (not significant). Kaplan-Meier survival curves based on age groups were not significantly different with 1- and 2-year survivals of 64% versus 55% and 29% versus 32%, respectively.
  
  
  CONCLUSIONS
  Our study demonstrates that whereas age may be associated with more comorbid conditions in patients with malignant pleural mesothelioma undergoing extended pleurectomy and decortication, this does not necessarily translate into increased operative morbidity or mortality or shorter long-term survival.
authors: Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago Medicine, Chicago, Illinois.
authors: Trevor
authors: T
authors: Williams
authors: Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago Medicine, Chicago, Illinois.
authors: Hadi
authors: H
authors: Duraid
authors: Department of Biostatistics, Section of Hematology and Oncology, University of Chicago Medicine, Chicago, Illinois.
authors: Sydeaka
authors: S
authors: Watson
authors: Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago Medicine, Chicago, Illinois.
authors: Amy
authors: A
authors: Durkin
authors: Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago Medicine, Chicago, Illinois.
authors: Kristy
authors: K
authors: Todd
authors: Department of Medicine, Section of Hematology and Oncology, University of Chicago Medicine, Chicago, Illinois.
authors: Hedy L
authors: HL
authors: Kindler
authors: Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago Medicine, Chicago, Illinois. Electronic address: wvignesw@surgery.bsd.uchicago.edu.
authors: Wickii T
authors: WT
authors: Vigneswaran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000601:surgery*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D010994:Pleura / Q000601:surgery*; D010997:Pleural Neoplasms / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome