Mangiameli Giuseppe, Bottoni Edoardo, Cariboni Umberto, Ferraroli Giorgio Maria, Morenghi Emanuela, Giudici Veronica Maria, Voulaz Emanuele, Alloisio Marco, Testori Alberto
Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy.
J Clin Med. 2022 Aug 3;11(15):4537. doi: 10.3390/jcm11154537.
Objectives: We examined a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent surgery in our institution during the last 20 years. Across this period, we changed our surgical approach to MPM, adopting extended pleurectomy and decortication (eP/D) instead of extrapleural pneumonectomy (EPP). In this study, we compare the perioperative outcomes and long-term survival of patients who underwent EPP vs. eP/D. Methods: A retrospective analysis was carried out of all the MPM patients identified from our departmental database who underwent EPP or P/D from 2000 to 2021. Clavien−Dindo criteria was adopted to score postoperative complications, while Kaplan−Meier methods and a Cox multivariable analysis were used to perform the survival analysis. Results: Of 163 patients, 78 (48%) underwent EPP and 85 (52%) eP/D. Induction chemotherapy was significantly administrated more often in the eP/D group (88% vs. 51%). Complete trimodality treatment including induction chemotherapy, radical surgery, and adjuvant radiotherapy was administered in 74% of the eP/D group versus 32% of the EPP group (p < 0.001). The postoperative morbidity rate was higher in the eP/D group (54%) compared to the EPP group (36%) (p = 0.02); no statistically significant differences were identified concerning major complications (EPP 43% vs. eP/D 24%, p = 0.08). No statistical differences were identified in 30-day mortality, 90-day mortality, median disease-free, and overall survival statistics between the two groups. The Cox multivariable analysis confirmed no induction chemotherapy (HR, 0.5; p = 0.002), RDW (HR, 1.08; p = 0.02), and the presence of pathological nodal disease (HR, 1.99; p = 0.001) as factors associated with worse survival in the entire series. Conclusions: Our data support that eP/D is a well-tolerated procedure allowing the implementation of a trimodality strategy (induction chemotherapy, surgery, and radiotherapy) in most MPM patients. When eP/D is offered in this setting, the oncological results are comparable to EPP. To obtain the best oncological results, the goal of surgical resection should be macroscopic complete resection (R0) in carefully selected patients (clinical N0).
我们研究了过去20年在我们机构连续接受手术的一系列恶性胸膜间皮瘤（MPM）患者。在此期间，我们改变了MPM的手术方式，采用扩大胸膜切除术和剥脱术（eP/D）而非胸膜外全肺切除术（EPP）。在本研究中，我们比较了接受EPP与eP/D患者的围手术期结局和长期生存率。方法：对2000年至2021年从我们科室数据库中识别出的所有接受EPP或P/D的MPM患者进行回顾性分析。采用Clavien-Dindo标准对术后并发症进行评分，同时使用Kaplan-Meier方法和Cox多变量分析进行生存分析。结果：163例患者中，78例（48%）接受了EPP，85例（52%）接受了eP/D。诱导化疗在eP/D组的应用显著更频繁（88%对51%）。74%的eP/D组接受了包括诱导化疗、根治性手术和辅助放疗的完整三联治疗，而EPP组为32%（p < 0.001）。eP/D组的术后发病率高于EPP组（54%对36%）（p = 0.02）；在主要并发症方面未发现统计学显著差异（EPP 43%对eP/D 24%，p = 0.08）。两组在30天死亡率、90天死亡率、无病生存期和总生存统计方面未发现统计学差异。Cox多变量分析证实，在整个系列中，未接受诱导化疗（HR，0.5；p = 0.002）、红细胞分布宽度（HR，1.08；p = 0.02）和存在病理性淋巴结疾病（HR，1.99；p = 0.001）是与较差生存相关的因素。结论：我们的数据支持eP/D是一种耐受性良好的手术方法，允许在大多数MPM患者中实施三联治疗策略（诱导化疗、手术和放疗）。在此情况下提供eP/D时，肿瘤学结果与EPP相当。为了获得最佳肿瘤学结果，手术切除的目标应是在精心挑选的患者（临床N0）中实现宏观完全切除（R0）。
