Sharkey Annabel J, Tenconi Sara, Nakas Apostolos, Waller David A
University of Leicester Hospitals Trust, Leicester, UK
IRCCS Arcispedale, Reggio Emilia, Italy.
Eur J Cardiothorac Surg. 2016 Jun;49(6):1632-41. doi: 10.1093/ejcts/ezv403. Epub 2015 Dec 3.
For many years, extrapleural pneumonectomy (EPP) was the operation of choice for the radical management of pleural mesothelioma in the UK. However, doubts surrounding the efficacy of EPP, and the change in demographics of the affected population, have prompted a transition in our practice towards extended pleurectomy/decortication (EPD). The aim of this study was to determine the effects an intentional transition from EPP to EPD has had on patient outcome.
Data from 362 patients undergoing radical surgery (229 EPD, 133 EPP) during 1999-2014 were included. Demographics and outcome were compared between the two groups; EPP versus EPD.
The median age of patients undergoing EPD was significantly higher than those undergoing EPP [57 years (range 14-70 years) vs 65 years (range 42-81 years), P < 0.001]. There was a significantly higher proportion of patients with performance status ≥1 in the EPD group (46.3 vs 35.4%, P = 0.047). There was no difference in the median length of hospital stay between the two groups [14 days (range 1-133 days) vs 13 days (range 0-93 days), P = 0.409]. There was also no difference between the groups in terms of in-hospital mortality (EPP 5.3% and EPD 6.6%, P = 0.389), 30-day mortality [EPP 8 (6.0%) and EPD 8 (3.5%), P = 0.294] or 90-day mortality [EPP 18 (13.5%) and EPD 21 (9.2%), P = 0.220]. There was a significantly higher early reoperation rate in the EPP group (15.0 vs 6.2%, P = 0.008) but a significantly higher late reoperation rate in the EPD group (0.8 vs 5.3%, P = 0.037). There was no significant difference in overall survival or disease-free interval between the two groups (P = 0.899 and P = 0.399, respectively). However, overall survival was significantly greater in patients over the age of 65 undergoing EPD (12.5 vs 4.7 months, P = 0.001).
The transition from EPP to EPD in our standard practice has enabled us to operate on more elderly, frail patients with no significant increase in use of hospital resources, and without detriment to overall survival.
多年来，在英国，胸膜外肺切除术（EPP）一直是根治性治疗胸膜间皮瘤的首选手术方式。然而，围绕EPP疗效的质疑以及患病人群人口统计学特征的变化，促使我们在实践中向扩大性胸膜剥脱术/去皮质术（EPD）转变。本研究的目的是确定从EPP有意转变为EPD对患者预后的影响。
纳入1999年至2014年间接受根治性手术的362例患者的数据（229例行EPD，133例行EPP）。比较两组患者的人口统计学特征和预后；EPP组与EPD组。
接受EPD的患者中位年龄显著高于接受EPP的患者[57岁（范围14 - 70岁）对65岁（范围42 - 81岁），P < 0.001]。EPD组中体能状态≥1的患者比例显著更高（46.3%对35.4%，P = 0.047）。两组患者的中位住院时间无差异[14天（范围1 - 133天）对13天（范围0 - 93天），P = 0.409]。两组在院内死亡率（EPP为5.3%，EPD为6.6%，P = 0.389）、30天死亡率[EPP为8例（6.0%），EPD为8例（3.5%），P = 0.294]或90天死亡率[EPP为18例（13.5%），EPD为21例（9.2%），P = 0.220]方面也无差异。EPP组的早期再次手术率显著更高（15.0%对6.2%，P = 0.008），但EPD组的晚期再次手术率显著更高（0.8%对5.3%，P = 0.037）。两组在总生存期或无病生存期方面无显著差异（分别为P = 0.899和P = 0.399）。然而，接受EPD的65岁以上患者的总生存期显著更长（12.5个月对4.7个月，P = 0.001）。
在我们的标准实践中从EPP转变为EPD，使我们能够为更多老年、体弱患者进行手术，而不会显著增加医院资源的使用，且不会损害总生存期。
