Background:
The best surgical treatment for malignant pleural mesothelioma is still under debate. Lung sparing cytoreductive surgery by extended pleurectomy and decortication (P/D) combined with hyperthermic intrathoracic chemoperfusion (HITHOC) and followed by additive chemotherapy represents a promising treatment strategy. Aim of the study was to investigate perioperative morbidity of P/D and HITHOC compared to extrapleural pneumonectomy (EPP) within a trimodal treatment approach in a high volume center and to analyze overall survival.
Methods:
A standardized P/D and HITHOC procedure was established in 2014. Clinical data of patients with epitheloid pleural mesothelioma treated by P/D and HITHOC or EPP were included in this analysis. To achieve comparable results, patients undergoing EPP within a trimodal treatment approach between 2000 and 2012 were matched by epitheloid subtype and sex. Survival data were analyzed according to Kaplan-Meier. Data are given as mean ± SD.
Results:
Between 2014 and 2018, 61 patients with epitheloid pleural mesothelioma were treated by P/D, HITHOC and additive chemotherapy among 53 (87%) were male. Mean age was 66.5 ± 7.9 years. In the cohort matched by tumor subtype and sex, 61 patients with a mean age of 57.7 ± 7.9 years were treated by neoadjuvant chemotherapy, EPP and adjuvant radiotherapy. Median overall survival was 42.2 months in the P/D group compared to 22.4 months for patients undergoing EPP.
Conclusion:
P/D and HITHOC appears safe in mesothelioma patients with increased overall survival compared to EPP within a trimodal treatment approach.
