Sixteen studies were included in the review. In total, 744 patients with malignant pleural mesothelioma were treated with extrapleural pneumonectomy, and 612 of them underwent trimodal therapy. Ten studies were retrospective and observational, five were prospective, and one was a feasibility study for a randomised controlled trial. Where reported, the follow-up ranged from 10 to 69 months.
Overall survival: With neoadjuvant chemotherapy, four prospective studies reported a median overall survival ranging from 16.8 to 25.5 months, and one randomised study reported a median survival of 14.4 months. The definition of overall survival differed between institutions. With adjuvant chemotherapy, seven studies reported a median overall survival ranging from 19 to 24 months, and one multicentre retrospective study reported a median survival of 46.9 months. Where specified, overall survival was defined as survival from the date of extrapleural pneumonectomy.
Disease-free survival: Disease-free survival was inconsistently reported and defined. Among four studies involving neoadjuvant chemotherapy, disease-free survival ranged from 10.1 to 16.3 months. Among three studies involving adjuvant chemotherapy disease-free survival ranged from 10 to 15 months.
Perioperative outcomes: Where reported, perioperative mortality ranged from none to 12.5%, perioperative morbidity ranged from 50% to 83%, major perioperative complications ranged from 24% to 54%, and the average reported length of stay ranged from nine to 14 days.
Disease recurrence: Where reported, local disease recurrence ranged from 4% to 41%, distant recurrence ranged from 5% to 65%, and overall disease recurrence ranged from 27% to 84%.