Japanese Association for Chest Surgery, Kyoto, Japan; Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
Japanese Association for Chest Surgery, Kyoto, Japan; Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Ann Thorac Surg. 2022 Apr;113(4):1348-1353. doi: 10.1016/j.athoracsur.2021.04.042. Epub 2021 Apr 27.
Few reports about surgical outcomes in malignant pleural mesothelioma (MPM) have been based on reliable nationwide databases. Here, we analyzed the incidence, surgical outcome, and operative risk factors using Japanese nationwide database.
Characteristics and perioperative data from 622 patients who underwent curative-intent surgery for MPM between January 2014 and December 2017 were recorded from National Clinical Database of Japan. We analyzed the incidence, surgical outcomes, and risk factors for surgical complications after 2 surgical procedures (extrapleural pneumonectomy [EPP] and pleurectomy/decortication [P/D]).
During 4 years, EPP was performed in 279 patients and P/D in 343. EPP was more frequently performed in institutions less experienced in MPM, while P/D was more frequently performed in institutions well experienced in MPM (P < .001), especially in high-volume centers with more than 10 cases during this period. P/D was more frequently performed, especially in high-volume centers. The morbidity rates were 45.2% in EPP and 35.9% in P/D. Heart failure and pneumonia were most frequent in EPP, while prolonged air leakage was most frequent in P/D. Thirty-day and in-hospital mortality rates were 1.1% and 3.2% (EPP) and 1.2% and 3.2% (P/D), respectively. Regression analyses revealed that higher age (>65 years) was associated with operative complications in EPP (odds ratio, 3.56 [95% confidence interval, 1.26-8.56]), whereas no risk factor was observed in P/D.
In Japanese nationwide annual database, P/D was more frequently performed, especially in high-volume centers. Morbidity was higher in EPP than P/D; however, the mortality rates were quite low in Japan regardless surgical procedures.
很少有关于恶性胸膜间皮瘤（MPM）手术结果的报告是基于可靠的全国性数据库。在这里，我们使用日本全国性数据库分析了发病率、手术结果和手术相关危险因素。
从日本全国临床数据库中记录了 2014 年 1 月至 2017 年 12 月期间 622 例接受根治性手术治疗的 MPM 患者的特征和围手术期数据。我们分析了两种手术（胸膜外全肺切除术[EPP]和胸膜切除术/剥脱术[P/D]）后手术并发症的发生率、手术结果和危险因素。
4 年内，279 例患者行 EPP，343 例行 P/D。EPP 在 MPM 经验较少的机构中更为常见，而 P/D 在 MPM 经验丰富的机构中更为常见（P＜0.001），尤其是在该期间进行了 10 例以上手术的高容量中心。P/D 更为常见，尤其是在高容量中心。EPP 的发病率为 45.2%，P/D 为 35.9%。EPP 中最常见的是心力衰竭和肺炎，而 P/D 中最常见的是长时间漏气。EPP 的 30 天和住院死亡率分别为 1.1%和 3.2%（EPP）和 1.2%和 3.2%（P/D）。回归分析显示，EPP 中年龄较大（＞65 岁）与手术并发症相关（优势比，3.56[95%置信区间，1.26-8.56]），而 P/D 中则无危险因素。
在日本全国年度数据库中，P/D 更为常见，尤其是在高容量中心。EPP 的发病率高于 P/D；然而，无论手术方式如何，日本的死亡率都相当低。
