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J Thorac Cardiovasc Surg 2009;138:619-624
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Extrapleural pneumonectomy for malignant pleural mesothelioma: Outcomes of treatment and prognostic factors

^a The University of Sydney, Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
^b The Baird Institute for Applied Heart and Lung Surgical, Sydney, Australia
^c Department of Medical Oncology, Sydney Cancer Center, Royal Prince Alfred Hospital, Sydney, Australia
^d Department of Radiation Oncology, Sydney Cancer Center, Royal Prince Alfred Hospital, Sydney, Australia

Received for publication August 26, 2008; revisions received December 2, 2008; accepted for publication December 28, 2008.

^_* Address for reprints: Brian C. McCaughan, MBBS, FRACS, 304/100 Carillon Avenue, Newtown, NSW 2042, Australia. (Email: bmccaughan{at}scts.com.au).

Objective: This study aimed to evaluate the perioperative and long-term outcomes associated with extrapleural pneumonectomy for patients with malignant pleural mesothelioma.

Methods: From October 1994 to April 2008, 70 patients were selected for extrapleural pneumonectomy. Univariate analysis was performed using the Kaplan–Meier method and compared using the log-rank test. Multivariate analysis with entering and removing limits of P less than .10 and P greater than .05, respectively, was used. The prognostic factors included age, gender, side of disease, asbestos exposure, histology, positron emission tomography, date of surgery, neoadjuvant chemotherapy, completeness of cytoreduction, lymph node involvement, perioperative morbidity, adjuvant radiotherapy, and pemetrexed-based chemotherapy.

Results: The mean age of patients was 55 years (standard deviation = 10). Fifty-eight patients had epithelial tumors. Six patients received neoadjuvant chemotherapy, 28 patients received adjuvant radiotherapy, and 16 patients received postoperative pemetrexed-based chemotherapy. Forty-four patients had no lymph node involvement. The perioperative morbidity and mortality were 37% and 5.7%, respectively. Complications included hemothorax (n = 7), atrial fibrillation (n = 6), empyema (n = 4), bronchopulmonary fistula (n = 3), right-sided heart failure (n = 2), pneumonia (n = 1), constrictive pericarditis (n = 1), acute pulmonary edema (n = 1), small bowel herniation (n = 1), and disseminated intravascular coagulopathy (n = 1). The median survival was 20 months, with a 3-year survival of 30%. Asbestos exposure, negative lymph node involvement, and receipt of adjuvant radiation or postoperative pemetrexed-based chemotherapy were associated with improved survival on both univariate and multivariate analyses.

Conclusion: The present study supports the use of extrapleural pneumonectomy-based multimodal therapy in carefully selected patients with malignant pleural mesothelioma.