METHODS: There were 285 patients with a median age of 66 years (range, 26 to 91 years). One hundred forty-six patients (51%) had biopsy only, 73 (26%) had extrapleural
pneumonectomy, 34 (12%) had subtotal parietal pleurectomy, 22 (8%) underwent exploration without resection, and 10 (3%) had total pleurectomy. Histopathology was epithelial, nonepithelial, and unclassified in 134, 108, and 43 patients, respectively. Twenty patients were stage IA, 82 patients were stage IB, 24 patients were stage II, 75 patients were stage III, 60 patients were stage IV, and 24 patients were of unknown stage. Fifty-three patients (19%) had
chemotherapy alone, 16 (5.6%) had radiation alone, and 42 (14.7%) had both. Thirty-day operative mortality was 6.3% and was not significantly associated with the operative procedure (p = 0.79). Fifty-one percent of extrapleural
pneumonectomy patients had major complications, significantly greater than patients having any other procedure (p < 0.001). Median follow-up was 11 months (range, 0 to 7 years). Overall median survival was 10.7 months; however, for patients having extrapleural
pneumonectomy, median survival was 16 months. One-, 2-, and 3-year survival after extrapleural
pneumonectomy was 61%, 25%, and 14%, respectively.
CONCLUSIONS: Extrapleural
pneumonectomy can be performed with similar 30-day mortality as other procedures for
malignant pleural mesothelioma with a median survival better than subtotal pleurectomy, exploration without resection, and biopsy alone. However, extrapleural
pneumonectomy has significant morbidity and a 3-year survival of only 14%.