Radical pleurectomy and chemoradiation for malignant pleural mesothelioma: The outcome of incomplete resections

Abstract

Background: The type of surgery (radical pleurectomy (RP) vs. extrapleural pneumonectomy (EPP)) remains controversial for malignant pleural mesothelioma (MPM). Macroscopic complete resection (MCR) is a key prognostic factor. It is unclear, if patients undergoing incomplete RP within a standardized multimodality treatment protocols have any advantage in terms of survival and if EPP could theoretically have avoided incomplete resections (R2). Methods: Eighty-eight patients underwent RP followed by chemoradiation from 2002 to 2011 within a prospective multimodality treatment study at a single institution. MCR were compared to R2 within this patient cohort retrospectively. EPP eligibility was assessed retrospectively based on preoperative cardiopulmonary testing and theoretical feasibility to achieve MCR. Kaplan-Meier analyses, log-rank test and Cox regression analyses were used to estimate survival and to determine predictors of survival. Results: For the complete patient cohort, median survival (MS) was 26.3 months (mo). MCR could be achieved in 64.8% (57/88). Compared to MCR patients, R2-patients (n=31, 35.2%) had an inferior overall survival (MS 13 vs. 33 mo, P < .0001) and inferior survival after disease progression (MS 4 vs. 11 mo; P< .0001), respectively. R2 was associated with advanced p-T-Status (P< .0001), p-N-Status (P=0.046) and p-IMIG stage (P