Retrospective comparison of symptomatic outcome between pleurectomy/decortication and extrapleural pneumonectomy in malignant pleural mesothelioma

Objectives: The effects on survival of pleurectomy/decortication and extrapleural pneumonectomy in malignant pleural mesothelioma are widely debated although they appear nearly equivalent. This study aims at comparing the impact of these procedures on symptoms and quality of life, which is a relatively new field of investigation. Methods: Between 1997 and 2009, 55 consecutive patients with malignant pleural mesothelioma underwent pleurectomy/decortication (n=26) or extrapleural pneumonectomy (n=29). Tumour-related symptoms and quality of life (Short Form-36 and St. George’s questionnaires) were pre- and postoperatively assessed and retrospectively compared. Results: Groups were homogeneous for main clinical variables. There was no perioperative mortality. Thirty-day postoperative major morbidity was 19% for pleurectomy/decortication and 41% for extrapleural pneumonectomy (P=0.07). After one month patients undergoing pleurectomy/decortications presented greater improvement rate in dyspnoea (62% vs. 41%, P=0.04), pain (73% vs. 59%, P=0.08), cough (62% vs. 48%, P=0.07), fever (69% vs. 52%, P=0.06), Karnofsky-index (62% vs. 48%, P=0.07), Short Form-36 physical component summary (58% vs. 41%, P=0.1), mental component summary (54% vs. 38%, P=0.09) and total St. George’s score (58% vs. 41%, P=0.1). At six months the improvement rates were almost equivalent, while at one year they were superior after extrapleural pneumonectomy: dyspnoea (59% vs. 44%, P=0.08), pain (59% vs. 39%, P=0.06), cough (53% vs. 39%, P=0.09), fever (59% vs. 44%, P=0.08), Karnofsky-index (53% vs. 39%, P=0.09), Short Form-36 physical component summary (53% vs. 39%, P=0.09), mental component summary (47% vs. 28%, P=0.06) and total St. George’s score (47% vs. 39%, P=0.13). Thereafter symptoms and quality of life worsened in both groups. No significant difference was found in long-term survival. Conclusions: Both procedures may improve symptomatic outcomes. In the early postoperative period greater improvements were experienced after pleurectomy/decortication, whereas extrapleural-pneumonectomy produced better symptom relief later.