{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:31:37Z","timestamp":1790289097242,"version":"4.1.0"},"reference-count":44,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T00:00:00Z","timestamp":1635206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: We analysed a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent extended Pleurectomy\/Decortication (eP\/D) in a centre with a high level of thoracic surgery experience (IRCCS Humanitas Research Hospital) to explore postoperative morbidity and mortality, pattern of recurrence and survival. Methods: A retrospective analysis was performed on MPM patients underwent eP\/D in our centre from 2010 to 2021. All patients were identified from our departmental database. Postoperative complications were scored according to Clavien\u2013Dindo criteria. Survival analysis was performed by the Kaplan\u2013Meier methods and Cox multivariable analysis. Results: Eighty-five patients underwent extended pleurectomy decortication (eP\/D) during study period. Macroscopical residual disease (R2) was reported in one case. A neoadjuvant chemotherapy regiment was administrated in 88% of the surgical cohort. A complete trimodality treatment including induction with platinum agents and pemetrexed, radical cytoreductive surgery and volumetric modulated arc therapy technology (VMAT) could be administered in 63 patients (74%). Postoperative morbidity rate was 54.11%, major complications (defined as Clavien\u2013Dindo \u2265 3) were reported in 11 patients (12.9%). Thirty-day mortality and 90-day mortality were, respectively, 2.35% and 3.53%. Median disease-free and overall survival were, respectively, 13.7 and 25.5 months. The occurrence of major complications (Clavien\u2013Dindo \u2265 3), operative time, pT3\u2013T4, pathological node involvement (pN+) were prognostic factors associated with worse survival. Conclusions: In our experience, eP\/D is a well-tolerated procedure with acceptable mortality and morbidity, allowing for the administration of trimodality regimens in most patients. eP\/D offered in a multimodality treatment setting have satisfactory long term oncological results. To obtain best oncological results the goal of surgery should be macroscopic complete resection in carefully selected patients (clinical N0).<\/jats:p>","DOI":"10.3390\/jcm10214968","type":"journal-article","created":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T23:54:33Z","timestamp":1635292473000},"page":"4968","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Extended Pleurectomy\/Decortication for Malignant Pleural Mesothelioma: Humanitas\u2019s Experience"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8394-2719","authenticated-orcid":false,"given":"Giuseppe","family":"Mangiameli","sequence":"first","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Bottoni","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Voulaz","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Cariboni","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Testori","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Crepaldi","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica Maria","family":"Giudici","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0254-3143","authenticated-orcid":false,"given":"Emanuela","family":"Morenghi","sequence":"additional","affiliation":[{"name":"Biostatistic Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Alloisio","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1289\/ehp.1002845","article-title":"Global Magnitude of Reported and Unreported Mesothelioma","volume":"119","author":"Park","year":"2011","journal-title":"Environ. Health Perspect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1093\/carcin\/bgz004","article-title":"Prognostic factors of survival in patients with malignant pleural mesothelioma: An analysis of the National Cancer Database","volume":"40","author":"Alpert","year":"2019","journal-title":"Carcinogenesis"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1038\/sj.bjc.6602307","article-title":"The expected burden of mesothelioma mortality in Great Britain from 2002 to 2050","volume":"92","author":"Hodgson","year":"2005","journal-title":"Br. J. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S390","DOI":"10.21037\/jtd.2018.01.116","article-title":"Pleurectomy\/decortication versus extrapleural pneumonectomy: A critical choice","volume":"10","author":"Filosso","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/00000658-199609000-00005","article-title":"Extrapleural Pneumonectomy in the Multimodality Therapy of Malignant Pleural Mesothelioma","volume":"224","author":"Sugarbaker","year":"1996","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.jtcvs.2014.10.041","article-title":"Pleurectomy\/decortication, hyperthermic pleural lavage with povidone-iodine, prophylactic radiotherapy, and systemic chemotherapy in patients with malignant pleural mesothelioma: A 10-year experience","volume":"149","author":"Bille","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.jtcvs.2004.02.021","article-title":"Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies","volume":"128","author":"Sugarbaker","year":"2004","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/S1470-2045(11)70149-8","article-title":"Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: Clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study","volume":"12","author":"Treasure","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.athoracsur.2014.09.056","article-title":"Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma","volume":"99","author":"Taioli","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","unstructured":"Network NCC (2020). Malignant Pleural Mesothelioma. NCCN Guidel., 2, 2020."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1093\/ejcts\/ezw215","article-title":"Comorbidity, postoperative morbidity and survival in patients undergoing radical surgery for malignant pleural mesothelioma","volume":"50","author":"Infante","year":"2016","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1093\/icvts\/ivaa332","article-title":"Exceptional thyrolipoma and thymolipoma association: Is there a syndrome?","volume":"32","author":"Mangiameli","year":"2021","journal-title":"Interact Cardiovasc. Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.pneumo.2018.03.009","article-title":"Cardiac compression of hydatid origin","volume":"74","author":"Bouassida","year":"2018","journal-title":"Rev. Pneumol. Clin."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1093\/annonc\/mdh059","article-title":"Modified RECIST criteria for assessment of response in malignant pleural mesothelioma","volume":"15","author":"Byrne","year":"2004","journal-title":"Ann. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.jtcvs.2007.10.054","article-title":"Extrapleural pneumonectomy versus pleurectomy\/decortication in the surgical management of malignant pleural mesothelioma: Results in 663 patients","volume":"135","author":"Flores","year":"2008","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.lungcan.2013.11.026","article-title":"A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma","volume":"83","author":"Cao","year":"2014","journal-title":"Lung Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1093\/ejcts\/ezr192","article-title":"Long-term survival after lung-sparing total pleurectomy for locally advanced (International Mesothelioma Interest Group Stage T3\u2013T4) non-sarcomatoid malignant pleural mesothelioma","volume":"41","author":"Nakas","year":"2011","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1097\/JTO.0b013e31824ab6c5","article-title":"Pleurectomy\/decortication is superior to extrapleural pneumonectomy in the multimodality management of patients with malignant pleural mesothelioma","volume":"7","author":"Bille","year":"2012","journal-title":"J. Thorac. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/ejcts\/ezs648","article-title":"Factors predicting poor survival after lung-sparing radical pleurectomy of IMIG stage III malignant pleural mesothelioma","volume":"44","author":"Bolukbas","year":"2013","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.jtcvs.2014.03.011","article-title":"Malignant pleural mesothelioma and the Society of Thoracic Surgeons Database: An analysis of surgical morbidity and mortality","volume":"148","author":"Burt","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1093\/ejcts\/ezt664","article-title":"Predictors of long-term survival following radical surgery for malignant pleural mesothelioma","volume":"46","author":"Nakas","year":"2014","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/JTO.0000000000000064","article-title":"Does surgery improve survival of patients with malignant pleural mesothelioma? A multicenter retrospective analysis of 1365 consecutive patients","volume":"9","author":"Bovolato","year":"2014","journal-title":"J. Thorac. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.jtcvs.2015.09.121","article-title":"Adoption of pleurectomy and decortication for malignant mesothelioma leads to similar survival as extrapleural pneumonectomy","volume":"151","author":"Batirel","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1016\/j.athoracsur.2019.11.048","article-title":"Clinical Outcomes With Recurrence After Pleurectomy\/Decortication for Malignant Pleural Mesothelioma","volume":"109","author":"Nakamura","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Zhou, N., Rice, D.C., Tsao, A.S., Lee, P.P., Haymaker, C.L., Corsini, E.M., Antonoff, M.B., Hofstetter, W.L., Rajaram, R., and Roth, J.A. (2021). Extrapleural Pneumonectomy versus Pleurectomy\/Decortication for Malignant Pleural Mesothelioma. Ann. Thorac. Surg.","DOI":"10.1016\/j.athoracsur.2021.04.078"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1002\/ccr3.1973","article-title":"Malignant pleural mesothelioma: Is reconstruction of the diaphragm necessary in left pleurectomy\/decortication? A case report","volume":"7","author":"Testori","year":"2019","journal-title":"Clin. Case Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/S0022-5223(99)70469-1","article-title":"Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: Results in 183 patients","volume":"117","author":"Sugarbaker","year":"1999","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_29","first-page":"S238","article-title":"Management of malignant pleural mesothelioma: The European experience","volume":"6","author":"Opitz","year":"2014","journal-title":"J. Thorac. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1016\/j.athoracsur.2014.05.071","article-title":"Extrapleural Pneumonectomy after Induction Chemotherapy: Perioperative Outcome in 251 Mesothelioma Patients from Three High-Volume Institutions","volume":"98","author":"Lauk","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1016\/j.athoracsur.2014.01.050","article-title":"Extrapleural Pneumonectomy for Malignant Mesothelioma: An Italian Multicenter Retrospective Study","volume":"97","author":"Spaggiari","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1183\/09031936.00039510","article-title":"Trimodality therapy for malignant pleural mesothelioma: Results from an EORTC phase II multicentre trial","volume":"36","author":"Baas","year":"2010","journal-title":"Eur. Respir. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1016\/j.athoracsur.2007.04.076","article-title":"Outcomes After Extrapleural Pneumonectomy and Intensity-Modulated Radiation Therapy for Malignant Pleural Mesothelioma","volume":"84","author":"Rice","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1097\/JTO.0b013e31827740f0","article-title":"Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma","volume":"8","author":"Gomez","year":"2013","journal-title":"J. Thorac. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Petrella, F., Casiraghi, M., Radice, D., Prisciandaro, E., Rizzo, S., and Spaggiari, L. (2020). Prognostic Value of Red Blood Cell Distribution Width in Resected pN1 Lung Adenocarcinoma. Cancers, 12.","DOI":"10.3390\/cancers12123677"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1177\/0300060513504163","article-title":"The value of inflammatory parameters in the prognosis of malignant mesothelioma","volume":"42","author":"Abakay","year":"2014","journal-title":"J. Int. Med. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1093\/icvts\/ivy275","article-title":"Perioperative outcomes of thoracoscopic lung resection requiring a long operative time","volume":"28","author":"Mori","year":"2019","journal-title":"Interact Cardiovasc. Thorac Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1097\/DCR.0000000000000114","article-title":"Longer operative time: Deterioration of clinical outcomes of laparoscopic colectomy versus open colectomy","volume":"57","author":"Bailey","year":"2014","journal-title":"Dis. Colon Rectum"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1097\/SLA.0000000000000903","article-title":"Extrapleural pneumonectomy in the treatment of epithelioid malignant pleural mesothelioma: Novel prognostic implications of combined N1 and N2 nodal involvement based on experience in 529 patients","volume":"260","author":"Sugarbaker","year":"2014","journal-title":"Ann. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Sobin, L.H., Gospodarowicz, M.K., and Wittekind, C. (2009). TNM Classification of Malignant Tumours, Wiley-Blackwell. [7th ed.].","DOI":"10.1002\/9780471420194.tnmc26"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"543","DOI":"10.21037\/tlcr.2018.07.05","article-title":"The eighth TNM classification for malignant pleural mesothelioma","volume":"7","author":"Berzenji","year":"2018","journal-title":"Transl. Lung Cancer Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.21037\/jtd.2018.01.174","article-title":"Adequacy of intra-operative nodal staging during lung cancer surgery: A poorly achieved minimum objective","volume":"10","author":"Riquet","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"4286","DOI":"10.21037\/jtd.2017.10.119","article-title":"Pathologic N1 disease in lung cancer: The segmental and subsegmental lymph nodes","volume":"9","author":"Riquet","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.21037\/jtd.2017.07.23","article-title":"Occult pN2 disease in lung cancer patients: A wide range of diseases endangering the long term prognosis","volume":"9","author":"Riquet","year":"2017","journal-title":"J. Thorac. Dis."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/4968\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:24:07Z","timestamp":1760167447000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/4968"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,26]]},"references-count":44,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["jcm10214968"],"URL":"https:\/\/doi.org\/10.3390\/jcm10214968","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,26]]}}}