Surgical Management of Malignant Pleural Mesothelioma: Impact of Surgery on Survival and Quality of Life—Relation to Chemotherapy, Radiotherapy, and Alternative Therapies
Introduction. Malignant pleural mesothelioma (MPM) is an aggressive cancer arising from pleural mesothelium. Surgery aims to either cure the disease or control the symptoms. Two surgical procedures exist: extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). In this systematic review we assess current evidence on safety and efficacy of surgery. Methods. Five electronic databases were reviewed from January 1990 to January 2013. Studies were selected according to a predefined protocol. Primary endpoint was overall survival. Secondary endpoints included quality of life, disease-free survival, disease recurrence, morbidity, and length of hospital stay. Results. Sixteen studies were included. Median survival ranged from 8.1 to 32 months for P/D and from 6.9 to 46.9 months for EPP. Perioperative mortality was 0%–9.8% and 3.2%–12.5%, respectively. Perioperative morbidity was 5.9%–55% for P/D and 10%–82.6% for EPP. Average length of stay was 7 days for P/D and 9 days for EPP. Conclusion. Current evidence cannot definitively answer which procedure (EPP or P/D) is more beneficial in terms of survival and operative risks. This systematic review suggests that surgery in the context of trimodality therapy offers acceptable perioperative outcomes and long-term survival. Centres specialising in MPM management have better results. 1. Introduction 1.1. Definition and Historical Facts Malignant mesothelioma is a term used to define aggressive tumours that involve mesothelial cells. These cells normally line body cavities, specifically pleura, peritoneum, pericardium, and testis. They can be localized or diffuse [1]. Worldwide incidence of mesothelioma is increasing. This is probably due to exposure of people to asbestos either knowingly or unknowingly. Asbestos has been proven to be associated with mesothelioma [2]. Historically, malignant mesothelioma was diagnosed in three groups of asbestos-exposed persons [3]. Initially it occurred in miners and millworkers who were directly exposed to asbestos in their work environment. Subsequently, mesothelioma was diagnosed in plumbers, carpenters, defence personnel, and insulation installers. Furthermore people living in industrial areas were inadvertently exposed to asbestos fibres released in the atmosphere [3]. 1.2. Social and Economic Impact Malignant mesothelioma in the UK has significant socioeconomic impact. More people die from mesothelioma than from melanoma or cervical cancer [4]. Deaths are expected to peak between 2010 and 2015 [5]. Similar rates are anticipated in Europe [6]. Elsewhere, for example,
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