PURPOSE: We have previously confirmed the feasibility of performing EPP in patients with early stage malignant pleural mesothelioma. However, we have found persistent nihilism associated with this type of surgery which may reduce potential referrals. We therefore aimed to demonstrate that EPP has a similar perioperative profile to pneumonectomy for NSCLC.
METHODS: In a 9 year retrospective review we identified 152 consecutive patients who underwent pneumonectomy : 46 for NSCLC and 106 patients EPP for MPM. We compared their perioperative course, ITU requirements, 30-day survival. All pneumonectomy for NSCLC was performed by single thoracotomy whereas median sternotomy has become our approach for right sided EPP, replacing two-level thoracotomy.
RESULTS: [expressed as median (range)] Patients undergoing EPP were likely to be younger: 57years [39-70] v 67years [47-88] (p<0.001) and male: 91% (96/106) v 63% (29/46) (p<0.001) than those undergoing pneumonectomy. EPP was associated with longer operating time 237 min [95-380] v 145 min [80-270] (p<0.001) and hospital stay 14 days [6-184] v 8 days [6-23] (p<0.001). There were no significant differences in ITU admission (2.1% v 7.4%, p=0.16), prevalence of AF (2.3% v 3.2%, p=0.5), chest infection (11.8% v 2.2%, p=0.2) or incidence of any complication (59.3% v 53.3%, p=0.67). Postoperative pain measured by epidural analgesia was similar: (280 ml [88-720] v 285 ml [58-605], p=0.8). There was no difference in 30-day mortality (6.7% v 13.1%, p=0.65).
CONCLUSION: Using standard selection criteria, EPP can be performed with similar outcome to pneumonectomy for NSCLC, but demands on hospital resources are greater with EPP.
CLINICAL IMPLICATIONS: EPP for malignant pleural mesothelioma can be performed with similar post operative morbidity and 30-day mortality as patients undergoing pneumonectomy for NSCLC.
DISCLOSURE: Paul Vaughan, None.