Abstract 51P
Background
Extrapleural pneumonectomy (EPP) is a procedure for salvage treatment of thoracic sarcoma with pleural involvement. It entails en-bloc resection of parietal and visceral pleura, lung, pericardium and homolateral diaphragm. Promising outcomes have been reported for selected patients in high-volume centres. We aimed to determine the characteristics and outcomes of adults who underwent EPP at a specialised centre.
Methods
We collected clinicopathologic variables, surgical and outcome details on eight patients who underwent EPP between 2010-2020. Primary outcomes were event-free survival (EFS) and overall survival (OS). Secondary outcomes were early and late postoperative complications.
Results
The clinicopathological variables and outcomes are shown in the table. At median follow-up of 22.5 months, six patients had disease recurrence: five died of disease (DoD) and one is alive with disease (AwD). Two patients had not recurred: one died of a radiation-related complication (esophageal rupture) and one is well with no evidence of disease (NED) at 37 months. Two patients received preoperative chemotherapy; both achieved partial metabolic response to doxorubicin/ifosfamide. Two patients received postoperative radiation. Characteristics of patients with the longest EFS included low-grade histology (patient 7, 37.0 m) and partial metabolic response to preoperative chemotherapy (patients 4 and 8, 42.3 m and 20.7 m). Early postoperative complications included: one ventilator-associated pneumonia with new-onset atrial fibrillation and two with hydropneumothorax. One late surgical complication involved infective endocarditis and septic shock. Table: 51P
Baseline characteristics and survival outcomes of EPP patients
| Patient | Age at EPP (years) | Diagnosis | Type of disease | Disease free interval from last recurrence (months) | Status at last follow-up | EFS (months) | OS (months) |
| 1 | 70 | Malignant solitary fibrous tumour | Primary | - | DoD | 16.4 | 20.7 |
| 2 | 64 | Intimal sarcoma | Primary | - | DoD | 2.0 | 2.4 |
| 3 | 22 | Synovial sarcoma | Recurrent | 6.3 | DoD | 2.7 | 8.3 |
| 4 | 36 | Synovial sarcoma | Primary | - | Died of radiation-related complication | 42.3 | 42.3 |
| 5 | 43 | Synovial sarcoma | Recurrent | 9.7 | DoD | 6.0 | 26.2 |
| 6 | 38 | Rhabdomyosarcoma | Recurrent | 2.3 | DoD | 3.2 | 12.5 |
| 7 | 44 | Chondrosarcoma, grade 1-2 | Recurrent | 8.4 | NED | 37.0 | 37.0 |
| 8 | 26 | Undifferentiated pleomorphic sarcoma | De novo metastatic | - | AwD | 20.7 | 23.0 |
Conclusions
In adult sarcoma patients, EPP is rarely curative but appears to be a feasible salvage procedure when performed at specialised centres. Patient selection is critical with a strong consideration for neoadjuvant systemic therapy to optimise oncological outcomes.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Chris O'Brien Lifehouse.
Funding
Has not received any funding.
Disclosure
A. Wilson-Smith: Financial Interests, Personal, Sponsor/Funding: Australian Government Research Training Program. M.C. Strach: Financial Interests, Personal, Funding: Specialised Therapeutics, European Society of Medical Oncology, Royal Prince Alfred Hospital Cancer services, The Royal Australasian College of Physicians, The Christie Charitable Funds; Financial Interests, Personal, Research Grant: ANZSA Clinical Research Fellowship. All other authors have declared no conflicts of interest.