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Ann Thorac Surg. 2014 Jun;97(6):1859-65. doi: 10.1016/j.athoracsur.2014.01.050. Epub 2014 Apr 14.

Extrapleural pneumonectomy for malignant mesothelioma: an Italian multicenter retrospective study.

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Thoracic Surgery Division, European Institute of Oncology, University of Milan, Milan, Italy. Electronic address:
Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Thoracic Surgery Unit, Community Hospital, Brescia, Italy.
Division of Thoracic Surgery, Humanitas Research Hospital-Rozzano, Milan, Italy.
Division of Thoracic Surgery, Ospedale di Mestre, Venezia-Mestre, Italy.
Department of Thoracic Surgery, University of Turin, San Giovanni Battista Hospital, Turin, Italy.
Division of Thoracic Surgery, IRCCS AOU "San Martino" IST, Genoa, Italy.
Thoracic Surgery Unit, Department of Surgical Oncology, National Cancer Institute, Rome, Italy.
Division of Surgery, Università-ASL, Chieti, Italy.
Thoracic Surgery Division, European Institute of Oncology, University of Milan, Milan, Italy.
Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.



This study assessed perioperative outcome and long-term survival in a large series of patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy (EPP) to identify prognostic factors allowing better patient selection.


We retrospectively collected data from nine referral centers for thoracic surgery in Italy. Perioperative outcome and survival data were available for 518 malignant pleural mesothelioma patients (84.4% with epithelial tumors, 68.0% with pathologic stage 3 disease) who underwent EPP with intention-to-treat (R0/R1) between 2000 and 2010. Induction chemotherapy was administered in 271 patients (52.3%) and adjuvant therapy in 373 patients (72.0%), including radiotherapy in 213 patients (41.1%), adjuvant chemotherapy in 43 patients (8.3%), and both in 117 patients (22.6%).


In all, 136 patients (26.3%) had major complications after EPP, and 36 (6.9%) died within 90 days after surgery. The median overall survival was 18 months, with a 1-, 2-, and 3-year overall survival of 65%, 41%, and 27%, respectively. At multivariable analysis adjusted for age and disease stage, male sex (hazard ratio [HR] 1.47, 95% confidence interval [CI]: 1.12 to 1.92), nonepithelial histology (HR 1.96, 95% CI: 1.48 to 2.58), and trimodality treatment using induction chemotherapy (HR 0.61, 95% CI: 0.43 to 0.85) were significantly associated with survival. Development of a major complication also significantly worsened outcome (HR 1.85, 95% CI: 1.37 to 2.50).


The success of EPP in the context of a multimodality treatment depends on a series of patient characteristics. Female patients, patients with epithelial tumors, and patients who received induction chemotherapy will best benefit from EPP.

[Indexed for MEDLINE]

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