Right extrapleural pneumonectomy for XXXX via median sternotomy or thoracotomy? Short- and long-term results.

@entity1 @entity3620 @entity5 @entity260
OBJECTIVE: To examine the short- and long-term results of right extrapleural pneumonectomy (EPP) for @entity3620 (MM) via median sternotomy or thoracotomy. METHODS: We analysed the results of EPP in consecutive @entity1 with early stage MM undergoing a radical surgery protocol for MM over a 7-year period. Initially thoracotomy, but later median sternotomy, was the incision of choice for @entity5 . The effects of the change of approach on perioperative course and survival were analysed. RESULTS: EPP was performed in 105 @entity1 (50 left thoracotomy, 22 right thoracotomy, 28 sternotomy, 5 combined sternotomy and right thoracotomy). Operation time was faster with median sternotomy than right thoracotomy (p=0.008). Right thoracotomy was associated with higher epidural infusion volume in the first 3 days than median sternotomy (p<0.001). There were fewer @entity260 in the sternotomy group (p=0.05). There were no differences in pathological stage, completeness of resection or duration of postoperative stay. Median survival following left thoracotomy, right thoracotomy and median sternotomy was 18.3, 8.5 and 17.7 months, respectively (p=0.02). Planned neoadjuvant or adjuvant chemotherapy was more common following median sternotomy than right thoracotomy (p=0.01). However, compared with the left thoracotomy and sternotomy groups, right EPP performed via thoracotomy was an independent predictor of poor prognosis (hazard ratio 2.3 (95% confidence intervals, CI 1.3-4.1), p=0.02). No wound complications or @entity5 recurrence have been observed following median sternotomy. CONCLUSIONS: Median sternotomy should be considered as an alternative approach to thoracotomy for right EPP.
