In recent years, there has been a shift from extrapleural pneumonectomy (EPP) toward
pleurectomy/decortication (P/D) as the preferred surgical technique. However, we occasionally
encounter difficult cases wherein visceral pleurectomy requires conversion to EPP
from P/D. We sought to clarify the preoperative risk factors and clinical outcomes
associated with conversion to EPP. We compared and analyzed conversion to EPP and
P/D between September 2012 and December 2019. Conversion to EPP was decided in case
of diffuse tumor invasion to the pulmonary parenchyma or due to failure of decortication.
Univariable regression analysis was performed to determine the association of preoperative
variables with conversion to EPP. Survival was analyzed by the Kaplan-Meier method
and log-rank test. Of the 181 patients who underwent intended P/D, 145 (80.1%) patients
underwent P/D and 18 (9.9%) patients underwent conversion to EPP. The sum of 3-level
pleural thickness (P < 0.001), maximum of 3-level pleural thickness (P = 0.006), and clinical T stage (P < 0.001) demonstrated association with conversion to EPP. Overall survival and progression-free
survival were significantly worse in the conversion to EPP group (median overall survival,
29.2 months vs 57.0 months [P = 0.008]; median progression-free survival, 15.3 months vs 23.2 months [P = 0.005]. Our data show that approximately 1 of every 10 patients with P/D intention
converted to EPP. Preoperative pleural thickness and clinical T stage may be risk
factors associated with conversion to EPP. The survival rate of conversion to EPP
was worse than that of P/D.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
ARDS (acute respiratory distress syndrome), CT (computed tomography), EPP (extrapleural pneumonectomy), eP/D (extended pleurectomy/decortication), FEV1 (force expiratory volume in 1 second), MCR (macroscopic complete resection), MPM (malignant pleural mesothelioma), NAC (neoadjuvant chemotherapy), P/D (pleurectomy/decortication), PFS (progression-free survival), PS (performance status), OR (odds ratio), OS (overall survival)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 17, 2021
Footnotes
Funding: None.
Conflicts of Interest: None.
Date and Number of IRB Approval: The institutional review board at the Hyogo College of Medicine (no. 3437) approved the study on February 25, 2020.
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Access this article on ScienceDirectLinked Article
- Commentary: To Preserve or Not Preserve (The Lung): That Is the MPM QuestionSeminars in Thoracic and Cardiovascular SurgeryVol. 33Issue 3
- PreviewDr Nakamura and colleagues report their experience with conversion to extrapleural pneumonectomy (EPP) during planned extended pleurectomy and decortication (ePD) for patients with malignant pleural mesothelioma (MPM).1 They found that the increase in preoperative tumor thickness at three levels (and T stage) was associated with conversion. Both the assessment of prognostic factors and the conversion strategy warrant discussion.
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