Short‐term outcomes of pleurectomy decortication and extrapleural pneumonectomy in mesothelioma

Background/Objectives We evaluated postoperative mortality and complications after extrapleural pneumonectomy (EPP) and pleurectomy decortication (P/D) to better understand their effectiveness in malignant pleural mesothelioma (MPM). Methods A meta‐analysis was done to evaluate 30‐day mortality and postoperative complications. In addition, in‐patients data of 500 eligible patients with MPM who underwent EPP or P/D was extracted from the New York Statewide Planning and Research Cooperative System (SPARCS). Multivariate analyses and propensity matching were used to compare in‐hospital mortality and postoperative complications in EPP vs P/D. Results The meta‐analysis showed a statistically significant difference in 30‐day mortality (5% [95% CI: 4‐6] vs P/D 2% [95% CI: 1‐3]), proportion of complications (46% [95% CI: 36‐56] vs 24% [95% CI: 15‐34]) and postoperative arrhythmias (20% [95% CI: 12‐31] vs 5% [95% CI: 2‐8]) for EPP vs P/D. In‐hospital mortality (OR adj : 2.6; 95% CI: 0.86‐7.75) and postoperative complications (OR adj : 1.1; 95% CI: 0.68‐1.86) were not different in EPP compared with P/D while supraventricular arrhythmia was significantly more frequent after EPP vs P/D (OR adj : 5.2; 95% CI: 2.34‐11.33). Conclusions Postoperative mortality, postoperative complications, and particularly supraventricular arrhythmia are less frequent after P/D vs EPP. P/D, a less invasive surgery, may provide a better option when technically feasible for patients with MPM.