PURPOSE: To examine the short and long term results of right extrapleural pneumonectomy (EPP) for malignant pleural mesothelioma (MM) via median sternotomy or thoracotomy.
METHODS: We have analysed the results of EPP in consecutive patients with early stage MM undergoing a radical surgery protocol for MM over a seven year period. Initially thoracotomy, but latterly median sternotomy, was the incision of choice for right sided tumours. The effects of the change of approach on perioperative course and survival was analysed. Clinical and pathological prognostic data were compared between groups.
RESULTS: EPP was performed in 105 patients (50 left thoracotomy, 22 right thoracotomy, 28 sternotomy, 5 combined sternotomy and right thoracotomy). Operation time was faster with median sternotomy than right thoracotomy (p=0.007). Right thoracotomy was associated with higher pain scores and epidural infusion volume (p<0.0001) than median sternotomy. There were no differences in pathological stage, postoperative morbidity or duration of postoperative stay. Median survival following left thoracotomy, right thoracotomy and median sternotomy was 658, 259 and 537 days, respectively (p=0.002). Planned neoadjuvant or adjuvant chemotherapy was more common following median sternotomy than right thoracotomy (p=0.02). However, right EPP performed via a sternotomy alone was an independent predictor of good prognosis (Hazard Ratio 2.9 (95%CI 1.3 –6.2), p=0.008). No wound complications or wound seedling have been observed following median sternotomy.
CONCLUSION: Right EPP performed via sternototomy was associated with a better survival than that performed via right thoracotomy. The traditionally accepted increased risk of right over left EPP was negated by this approach.
CLINICAL IMPLICATIONS: Right EPP should be performed via median sternotomy.
DISCLOSURE: John Edwards, None.