Survival and mortality after extrapleural pneumonectomy versus pleurectomy/decortication for malignant pleural mesothelioma: a systematic review

Abstract
Background
Surgery for malignant pleural mesothelioma (MPM) has always been a source of debate since no strong evidence exists for performing a radical surgical intervention. We aim to systematically review and compare different macroscopic resection procedures. A systematic Review on PUBMED/MEDLINE, EMBASE, and COCHRANE LIBRARY from Inception until March 2024 was performed to search for all studies comparing the 30-day mortality and overall survival after extrapleural pneumonectomy (EPP) and Pleurectomy decortication or extended Pleurectomy decortication (PD/EPD). We excluded studies with less than 10 patients, case reports, and articles with no endpoints.

Main body
Our electronic search retrieved 18,124 citations of which 22 studies fulfilled our criteria. The median 30-day mortality for PD/EPD was 2.2% (range 0–4%) while the median overall survival was 21 months (range 10.4–36 months) while EPP has a median 30-day mortality of 6% (range 0–11.8%) with a median overall survival of 18.1 months (range 9.3–35 months).

Conclusion
Surgery for MPM should be for selected patients and performed in specialized centers after discussions in multidisciplinary team meetings. PD/EPD seems to be associated with a lower 30-day mortality rate and a superior overall survival and should be considered the first radical option if surgery is deemed appropriate for patients.