Survival and mortality after extrapleural pneumonectomy versus pleurectomy/decortication for malignant pleural mesothelioma: a systematic review

Surgery for malignant pleural mesothelioma (MPM) has always been a source of debate since no strong evidence exists for performing a radical surgical intervention. We aim to systematically review and compare different macroscopic resection procedures. A systematic Review on PUBMED/MEDLINE, EMBASE, and COCHRANE LIBRARY from Inception until March 2024 was performed to search for all studies comparing the 30-day mortality and overall survival after extrapleural pneumonectomy (EPP) and Pleurectomy decortication or extended Pleurectomy decortication (PD/EPD). We excluded studies with less than 10 patients, case reports, and articles with no endpoints.

Our electronic search retrieved 18,124 citations of which 22 studies fulfilled our criteria. The median 30-day mortality for PD/EPD was 2.2% (range 0–4%) while the median overall survival was 21 months (range 10.4–36 months) while EPP has a median 30-day mortality of 6% (range 0–11.8%) with a median overall survival of 18.1 months (range 9.3–35 months).

Surgery for MPM should be for selected patients and performed in specialized centers after discussions in multidisciplinary team meetings. PD/EPD seems to be associated with a lower 30-day mortality rate and a superior overall survival and should be considered the first radical option if surgery is deemed appropriate for patients.