Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Australia.
J Thorac Oncol. 2010 Oct;5(10):1692-703. doi: 10.1097/JTO.0b013e3181ed0489.
The primary objective of the present systematic review was to evaluate the safety and efficacy of extrapleural pneumonectomy (EPP) for patients with malignant pleural mesothelioma.
A systematic review of relevant studies identified through five online search databases was performed. Two reviewers independently appraised each study.
Thirty-four of 58 relevant studies from 26 institutions containing the most updated data were evaluated for survival and perioperative outcomes after EPP. The median overall survival varied from 9.4 to 27.5 months, and 1-, 2-, and 5-year survival rates ranged from 36 to 83%, 5 to 59%, and 0 to 24%, respectively. Overall perioperative mortality rates ranged from 0 to 11.8%, and the perioperative morbidity rates ranged from 22 to 82%. Quality of life assessments from three studies reported improvements in nearly all domains at 3 months postoperatively. Patients who underwent trimodality therapy involving EPP and adjuvant chemoradiotherapy had a median overall survival of 13 to 23.9 months.
The current evidence suggests that selected patients with malignant pleural mesothelioma may benefit from EPP, especially when combined with neoadjuvant or adjuvant chemotherapy and adjuvant radiotherapy.
本系统评价的主要目的是评估恶性胸膜间皮瘤患者行胸膜外全肺切除术（EPP）的安全性和疗效。
通过五个在线搜索数据库对相关研究进行了系统评价。两位审查员独立评估了每项研究。
对 26 家机构的 58 项相关研究中的 34 项进行了评估，这些研究提供了 EPP 后生存和围手术期结局的最新数据。中位总生存期从 9.4 个月到 27.5 个月不等，1 年、2 年和 5 年生存率分别为 36%到 83%、5%到 59%和 0%到 24%。总体围手术期死亡率从 0%到 11.8%不等，围手术期发病率从 22%到 82%不等。来自三项研究的生活质量评估报告称，术后 3 个月几乎所有领域的生活质量都有所改善。接受包括 EPP 和辅助放化疗的三联疗法的患者，中位总生存期为 13 至 23.9 个月。
目前的证据表明，选择的恶性胸膜间皮瘤患者可能从 EPP 中获益，尤其是当与新辅助或辅助化疗和辅助放疗联合使用时。
