Comorbidity, postoperative morbidity and survival in patients undergoing radical surgery for malignant pleural mesothelioma

Maurizio Infante, Emanuela Morenghi, Edoardo Bottoni, Paolo Andrea Zucali, Daoud Rahal, Andrea Morlacchi, Anna Maria Ascolese, Fiorenza De Rose, Pierina Navarria, Alessandro Crepaldi, Alberto Testori, Emanuele Voulaz, Valentina Errico, M. Perrino, Marta Scorsetti, Arturo Chiti, Armando Santoro, Marco Alloisio

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: We examined a series of malignant pleural mesothelioma (MPM) patients who underwent radical surgery to explore relationships among comorbidity, postoperative morbidity and survival.

METHODS: A retrospective analysis was carried out of all MPM patients operated on in a single centre from 2000 to 2015. The Charlson Comorbidity Index (CCI) was used to classify patients according to their underlying condition. Postoperative complications were scored according to WHO-derived criteria. Survival comparisons were performed by Cox analysis.

RESULTS: Ninety-one patients underwent extrapleural pneumonectomy (EPP), 47 underwent pleurectomy decortication (PD) and 25 underwent palliative pleurectomy. The mean CCI of PD patients was significantly higher compared with that of EPP patients (P= 0.044). The frequency of grade 3+ complications was similar between EPP and PD (27 vs 26%). However, EPP patients had a 6-fold higher frequency of pleural sepsis (24 vs 4%, P= 0.002) occurring up to 695 days postoperatively. Median overall survival was 19 months (95% CI 13-25) after EPP, 30 months (95% CI 20-35) after PD and 13 months (95% CI 5-32) after palliative pleurectomy. At multivariate analysis, CCI (P< 0.001), histology (P= 0.014) and pleural sepsis (P= 0.001), but not complete resection, were significantly associated with survival. There was a trend in favour of PD over palliative resection after adjusting for histology and CCI.

CONCLUSIONS: The CCI is an independent predictor of survival in MPM patients undergoing radical surgery. Owing to its significant frequency and adverse impact, pleural sepsis may contribute to a reduced life expectancy after EPP. Surgical treatment of MPM remains debatable.

Original languageEnglish
Pages (from-to)1077-1082
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number6
Publication statusPublished - Dec 2016


  • Journal Article


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