A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma
A partir d'une revue systématique de la littérature publiée jusqu'en septembre 2013 (7 études, 1 145 patients), cette méta-analyse compare, du point de vue de la survie globale à long terme, de la mortalité et de la morbidité péri-opératoires, l'efficacité d'une pneumonectomie extrapleurale et d'une pleurectomie avec décortication chez les patients atteints d'un mésothéliome pleural malin
Background : Malignant pleural mesothelioma (MPM) is an aggressive disease of the pleural lining with a dismal prognosis. Surgical treatments of MPM with a curative intent include extrapleural pneumonectomy and extended pleurectomy/decortication (P/D). This meta-analysis aimed to compare the perioperative and long-term outcomes of EPP and extended P/D for selected surgical candidates. Methods : A systematic review of the literature was performed on five electronic databases to identify all relevant data on comparative outcomes of extended P/D and EPP in a multimodality setting. Endpoints included perioperative mortality and morbidity, as well as long-term overall survival. Results : Seven relevant studies with comparative data on EPP (n= 632) versus extended P/D (n = 513) were identified from the current literature. Comparison of these two groups demonstrated significantly lower perioperative mortality (2.9% vs 6.8%, p = 0.02) and morbidity (27.9% vs 62.0%, p < 0.0001) for patients who underwent extended P/D compared to EPP. Median overall survival ranged between 13–29 months for extended P/D and 12–22 months for EPP, with a trend favouring extended P/D. Conclusions : Although it must be emphasized that patient selection and treatment strategies differ between EPP and extended P/D, a number of comparative studies have recently been conducted to compare these two surgical techniques for patients with resectable MPM. The present study indicated that selected patients who underwent extended P/D had lower perioperative morbidity and mortality with similar, if not superior, long-term survival compared to EPP, in the context of multi-modality therapy. This may represent an important paradigm shift in the surgical management of MPM.