Late Breaking Abstract - Comparison of VATS debulking surgery and HITHOC vs VATS talc pleurodesis alone in malignant pleural mesothelioma: a pilot study

Introduction: Although several Authors have emphasized the importance of surgery to obtain long term survival in malignant pleural mesothelioma (MPM), no study identifies evident reasons to convince surgeons to decide for one or another technique. Aim: prospective randomized bi-centric pilot study to investigate the effects and survival of VATS debulking surgery and HITHOC vs VATS-talc pleurodesis in MPM. Method: Patients with MPM were assigned to 2-groups: a) VATS-talc pleurodesis; b) VATS-PD and HITHOC. Several factors and Kaplan-Meier survival curves have been analyzed. Results: 27 patients, 24 male, mean-age 66 (48-82) were enrolled. All patients were stage I-II. 14 pts in group A, 13 pts group B. Age, stage, histology, early complication, hospital stay and quality of life did not differ. Survival after the operation was 19.6 months (group A) vs 31.6 months (group B). Survival after diagnosis was 19.6 months (group A) vs 33.0 (group B). One and 2-year survival was 57% and 28,6% for group A and 69% and 54% group B. A divergent curve at Kaplan Meier analysis at 3 years (fig 1). One patient of group B underwent 2 reoperation. Mortality was 0. Conclusion: VATS debulking surgery and HITHOC may be preferred in MPM because 3-year survival was longer compared to VATS pleurodesis, while safety and tolerability were similar. This study could stimulate larger randomized studies.