Next Article in Journal
The Association Between Early Progesterone Rise and Serum Estradiol Levels as Well as Endometrial Thickness in IVF Cycles
Previous Article in Journal
Application of Artificial Intelligence in Inborn Errors of Immunity Identification and Management: Past, Present, and Future: A Systematic Review
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Systematic Review

Pleurectomy/Decortication Versus Extrapleural Pneumonectomy in Pleural Mesothelioma: A Systematic Review and Meta-Analysis of Survival, Mortality, and Surgical Trends

1
Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
2
Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
*
Author to whom correspondence should be addressed.
These authors equally contributed to this manuscript.
J. Clin. Med. 2025, 14(17), 5964; https://doi.org/10.3390/jcm14175964 (registering DOI)
Submission received: 20 July 2025 / Revised: 15 August 2025 / Accepted: 19 August 2025 / Published: 23 August 2025
(This article belongs to the Section Respiratory Medicine)

Abstract

Background: The optimal surgical approach for malignant pleural mesothelioma (PM) remains a topic of debate. While extrapleural pneumonectomy (EPP) offers radical resection, it is associated with significant morbidity. Pleurectomy/decortication (P/D) is less extensive but may offer comparable oncologic outcomes with reduced perioperative risk. This study aimed to conduct a comprehensive systematic review and meta-analysis to systematically evaluate and quantitatively compare survival outcomes, 30-day postoperative mortality, and baseline characteristics between patients undergoing P/D and EPP for PM. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. MEDLINE, Embase, and Scopus were searched up to May 2025. Studies comparing EPP and P/D in PM that reported on survival, mortality, or baseline demographics were included. Data from 24 retrospective studies were extracted. Pooled estimates were calculated using random-effects models. Meta-regression and subgroup analyses were performed by geographic region and publication year. Results: P/D was associated with a significantly improved overall survival compared to EPP in the primary analysis (mean difference = 7.01 months; 95% CI: 1.15–12.86; p = 0.018), with substantial heterogeneity (I2 = 98.5%). In a sensitivity analysis excluding one statistical outlier, the survival benefit remained significant (mean difference = 4.31 months; 95% CI: 1.69–6.93), and heterogeneity was markedly reduced. The 30-day mortality rate was also significantly lower for P/D (odds ratio = 0.34; 95% CI: 0.13–0.88; p = 0.027). Patients undergoing P/D were, on average, 3.78 years older than those undergoing EPP (p < 0.001), whereas no significant difference was observed in the sex distribution between groups. Subgroup analyses by region and publication year confirmed the robustness of the findings. Meta-regression did not reveal substantial modifiers of survival. Conclusions: P/D demonstrates superior overall survival and reduced perioperative mortality compared to EPP, without evidence of baseline demographic confounding. These findings, derived from retrospective comparative studies, support the preferential use of P/D in eligible patients, particularly in high-volume centers, given its favorable safety profile and superior median survival. However, the absence of randomized trials directly comparing P/D and EPP and the potential influence of patient selection warrant cautious interpretation, and surgical decisions should be tailored to individual patient factors within a multidisciplinary setting.
Keywords: pleural mesothelioma; pleurectomy/decortication; extrapleural pneumonectomy; systematic review; meta-analysis; lung cancer; surgical outcomes pleural mesothelioma; pleurectomy/decortication; extrapleural pneumonectomy; systematic review; meta-analysis; lung cancer; surgical outcomes

Share and Cite

MDPI and ACS Style

Brivio, M.; Chiari, M.; Bardoni, C.; Mazzella, A.; Casiraghi, M.; Spaggiari, L.; Bertolaccini, L. Pleurectomy/Decortication Versus Extrapleural Pneumonectomy in Pleural Mesothelioma: A Systematic Review and Meta-Analysis of Survival, Mortality, and Surgical Trends. J. Clin. Med. 2025, 14, 5964. https://doi.org/10.3390/jcm14175964

AMA Style

Brivio M, Chiari M, Bardoni C, Mazzella A, Casiraghi M, Spaggiari L, Bertolaccini L. Pleurectomy/Decortication Versus Extrapleural Pneumonectomy in Pleural Mesothelioma: A Systematic Review and Meta-Analysis of Survival, Mortality, and Surgical Trends. Journal of Clinical Medicine. 2025; 14(17):5964. https://doi.org/10.3390/jcm14175964

Chicago/Turabian Style

Brivio, Margherita, Matteo Chiari, Claudia Bardoni, Antonio Mazzella, Monica Casiraghi, Lorenzo Spaggiari, and Luca Bertolaccini. 2025. "Pleurectomy/Decortication Versus Extrapleural Pneumonectomy in Pleural Mesothelioma: A Systematic Review and Meta-Analysis of Survival, Mortality, and Surgical Trends" Journal of Clinical Medicine 14, no. 17: 5964. https://doi.org/10.3390/jcm14175964

APA Style

Brivio, M., Chiari, M., Bardoni, C., Mazzella, A., Casiraghi, M., Spaggiari, L., & Bertolaccini, L. (2025). Pleurectomy/Decortication Versus Extrapleural Pneumonectomy in Pleural Mesothelioma: A Systematic Review and Meta-Analysis of Survival, Mortality, and Surgical Trends. Journal of Clinical Medicine, 14(17), 5964. https://doi.org/10.3390/jcm14175964

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop