Updates Surg. 2026 Jun 01.
Giuseppe Mangiameli,
Debora Brascia,
Emanuela Re Cecconi,
Veronica Maria Giudici,
Edoardo Bottoni,
Alessandro Crepaldi,
Umberto Cariboni,
Alberto Testori,
Paolo Zucali,
Matteo Perrino,
Nadia Cordua,
Armando Santoro,
Marco Alloisio,
Giuseppe Marulli.
The role of surgery in malignant pleural mesothelioma (MPM) remains controversial, particularly after the negative results of the MARS 1 and 2 trials. Lung-sparing cytoreductive procedures such as extended pleurectomy/decortication (eP/D) are increasingly adopted in high-volume centers, but real-world outcomes within multimodality pathways vary widely. This study analyzes our Institutional experience with parenchyma-sparing surgery in a trimodal strategy, focusing on perioperative outcomes, recurrence patterns, and survival, with particular attention to the prognostic impact of nodal status. We conducted a retrospective observational study including consecutive patients with epithelioid MPM who underwent eP/D with curative intent between 2010 and 2022 at a single tertiary Center. All patients were evaluated within a multidisciplinary framework and routinely received platinum-pemetrexed induction chemotherapy. Clinical, pathological, perioperative, and follow-up data were prospectively recorded. Survival was analyzed using Kaplan-Meier curves and Cox regression. A total of 102 patients were included. Median age was 65.9 years, and 75% were males. Most patients (90%) received induction chemotherapy and 70% completed full trimodality therapy. Median hospital stay was 14 days (IQR 10.3-19.0). Postoperative morbidity occurred in 52% of patients, with major complications in 13%; 30 day and 90 day mortality were 1 and 3%, respectively. Recurrence occurred in 72% of cases, predominantly locoregional. Median disease-free survival (DFS) was 11.7 months (IQR 7.9-18.7) and median overall survival (OS) was 28.0 months (IQR 14.8-48.8). Nodal metastasis was associated with significantly worse OS (34.4 vs 17.4 months, p = 0.004), whereas completion of trimodal therapy did not significantly affect DFS or OS. Lung-sparing cytoreduction within a structured multimodality pathway is safe and achieves survival comparable to major international series. Pathological nodal status represents the strongest prognostic determinant and may guide risk-adapted treatment strategies in the evolving era of multimodal therapy.
Keywords: Extended pleurectomy/decortication; Malignant pleural mesothelioma; Multimodality therapy; Pleurectomy/decortication