Extrapleural pneumonectomy versus pleurectomy/decortication in malignant pleural mesothelioma: an updated meta-analysis of survival endpoints

Background: Malignant pleural mesothelioma (MPM) is a rare malignancy that is associated with poor prognosis. The use of pleurectomy/decortication (P/D) surgical approach has received attention as a less invasive lung-sparing approach in comparison with extrapleural pneumonectomy (EPP). Aim: We reviewed the available literature on patients with MPM undergoing either EPP or P/D, in order to evaluate which procedure is superior in terms of survival. Methods: We identified original studies that compared the long-term outcomes of P/D and EPP, from 1990 to 2018. The 30-days and 90-days mortality, along with the 1-,2-,3-,5-year survival and the median overall survival (OS) were the primary endpoints. The complications were the secondary endpoints. Both a fixed and a random effect model were used appropriately. The Q statistic and I2 statistic were used to assess the heterogeneity among studies. Results: Fifteen studies were included (kappa=0.906; 95% CI: 0.801, 1.000), incorporating a total of n=3908 patients treated with either EPP (n=1672) or P/D (n=2236). The 30-day mortality was significantly higher in the EPP group (OR:3.24 [95% CI:1.70, 6.20]; p Conclusion: P/D is associated with enhanced outcomes and should be preferred when technically feasible.