Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience

Background: We analysed a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent extended Pleurectomy/Decortication (eP/D) in a centre with a high level of thoracic surgery experience (IRCCS Humanitas Research Hospital) to explore postoperative morbidity and mortality, p...

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Autores principales:	Giuseppe Mangiameli, Edoardo Bottoni, Emanuele Voulaz, Umberto Cariboni, Alberto Testori, Alessandro Crepaldi, Veronica Maria Giudici, Emanuela Morenghi, Marco Alloisio
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	malignant pleural mesothelioma extended pleurectomy/decortication (eP/D) trimodality treatment Medicine R
Acceso en línea:	https://doaj.org/article/38fb7eae435f466ba99b3a0d1df1bfc7
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spelling	oai:doaj.org-article:38fb7eae435f466ba99b3a0d1df1bfc72021-11-11T17:36:04ZExtended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience10.3390/jcm102149682077-0383https://doaj.org/article/38fb7eae435f466ba99b3a0d1df1bfc72021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4968https://doaj.org/toc/2077-0383Background: We analysed a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent extended Pleurectomy/Decortication (eP/D) in a centre with a high level of thoracic surgery experience (IRCCS Humanitas Research Hospital) to explore postoperative morbidity and mortality, pattern of recurrence and survival. Methods: A retrospective analysis was performed on MPM patients underwent eP/D in our centre from 2010 to 2021. All patients were identified from our departmental database. Postoperative complications were scored according to Clavien–Dindo criteria. Survival analysis was performed by the Kaplan–Meier methods and Cox multivariable analysis. Results: Eighty-five patients underwent extended pleurectomy decortication (eP/D) during study period. Macroscopical residual disease (R2) was reported in one case. A neoadjuvant chemotherapy regiment was administrated in 88% of the surgical cohort. A complete trimodality treatment including induction with platinum agents and pemetrexed, radical cytoreductive surgery and volumetric modulated arc therapy technology (VMAT) could be administered in 63 patients (74%). Postoperative morbidity rate was 54.11%, major complications (defined as Clavien–Dindo ≥ 3) were reported in 11 patients (12.9%). Thirty-day mortality and 90-day mortality were, respectively, 2.35% and 3.53%. Median disease-free and overall survival were, respectively, 13.7 and 25.5 months. The occurrence of major complications (Clavien–Dindo ≥ 3), operative time, pT3–T4, pathological node involvement (pN+) were prognostic factors associated with worse survival. Conclusions: In our experience, eP/D is a well-tolerated procedure with acceptable mortality and morbidity, allowing for the administration of trimodality regimens in most patients. eP/D offered in a multimodality treatment setting have satisfactory long term oncological results. To obtain best oncological results the goal of surgery should be macroscopic complete resection in carefully selected patients (clinical N0).Giuseppe MangiameliEdoardo BottoniEmanuele VoulazUmberto CariboniAlberto TestoriAlessandro CrepaldiVeronica Maria GiudiciEmanuela MorenghiMarco AlloisioMDPI AGarticlemalignant pleural mesotheliomaextended pleurectomy/decortication (eP/D)trimodality treatmentMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4968, p 4968 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	malignant pleural mesothelioma extended pleurectomy/decortication (eP/D) trimodality treatment Medicine R
spellingShingle	malignant pleural mesothelioma extended pleurectomy/decortication (eP/D) trimodality treatment Medicine R Giuseppe Mangiameli Edoardo Bottoni Emanuele Voulaz Umberto Cariboni Alberto Testori Alessandro Crepaldi Veronica Maria Giudici Emanuela Morenghi Marco Alloisio Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience
description	Background: We analysed a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent extended Pleurectomy/Decortication (eP/D) in a centre with a high level of thoracic surgery experience (IRCCS Humanitas Research Hospital) to explore postoperative morbidity and mortality, pattern of recurrence and survival. Methods: A retrospective analysis was performed on MPM patients underwent eP/D in our centre from 2010 to 2021. All patients were identified from our departmental database. Postoperative complications were scored according to Clavien–Dindo criteria. Survival analysis was performed by the Kaplan–Meier methods and Cox multivariable analysis. Results: Eighty-five patients underwent extended pleurectomy decortication (eP/D) during study period. Macroscopical residual disease (R2) was reported in one case. A neoadjuvant chemotherapy regiment was administrated in 88% of the surgical cohort. A complete trimodality treatment including induction with platinum agents and pemetrexed, radical cytoreductive surgery and volumetric modulated arc therapy technology (VMAT) could be administered in 63 patients (74%). Postoperative morbidity rate was 54.11%, major complications (defined as Clavien–Dindo ≥ 3) were reported in 11 patients (12.9%). Thirty-day mortality and 90-day mortality were, respectively, 2.35% and 3.53%. Median disease-free and overall survival were, respectively, 13.7 and 25.5 months. The occurrence of major complications (Clavien–Dindo ≥ 3), operative time, pT3–T4, pathological node involvement (pN+) were prognostic factors associated with worse survival. Conclusions: In our experience, eP/D is a well-tolerated procedure with acceptable mortality and morbidity, allowing for the administration of trimodality regimens in most patients. eP/D offered in a multimodality treatment setting have satisfactory long term oncological results. To obtain best oncological results the goal of surgery should be macroscopic complete resection in carefully selected patients (clinical N0).
format	article
author	Giuseppe Mangiameli Edoardo Bottoni Emanuele Voulaz Umberto Cariboni Alberto Testori Alessandro Crepaldi Veronica Maria Giudici Emanuela Morenghi Marco Alloisio
author_facet	Giuseppe Mangiameli Edoardo Bottoni Emanuele Voulaz Umberto Cariboni Alberto Testori Alessandro Crepaldi Veronica Maria Giudici Emanuela Morenghi Marco Alloisio
author_sort	Giuseppe Mangiameli
title	Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience
title_short	Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience
title_full	Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience
title_fullStr	Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience
title_full_unstemmed	Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience
title_sort	extended pleurectomy/decortication for malignant pleural mesothelioma: humanitas’s experience
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/38fb7eae435f466ba99b3a0d1df1bfc7
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Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience

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