Mesothelioma patients who are candidates for surgery will have better outcomes and longer survival if their procedure is done in a specialty treatment center by a surgeon experienced in mesothelioma surgery.
That is the conclusion of a team of surgeons in the Department of Cardiothoracic Surgery at Royal Prince Alfred Hospital in Sydney, Australia. The group set out to determine if survival statistics for mesothelioma surgery have improved over the years as doctors have gained more experience treating mesothelioma and adjuvant therapies have advanced.
They analyzed the surgical treatments and survival results of 540 consecutive patients with malignant plural mesothelioma. The group was divided into two segments of 270 patients each. The first group was comprised of mesothelioma patients who had surgery prior to September 1999. The second group was made up of those who had surgery after that date.
But the date was not the only thing that separated the two mesothelioma groups. In addition to having a higher proportion of epithelial tumors, patients in the second group were also more likely to have had preoperative PET scans and postoperative radiotherapy and pemetrexed-based chemotherapy. Mesothelioma patients in the second group were also more likely to have been treated with extrapleural pneumonectomy (EPP), the most radical type of mesothelioma surgery.
In their comparison of the two mesothelioma groups, published in the June 2011 issue of the Annals of Thoracic and Cardiovascular Surgery, the authors write, “Four factors were found to be independently associated with an improved survival in multivariate analysis: epithelial subtype, surgeon’s experience with a hundred cases or more, patients who underwent EPP and those who received pemetrexed chemotherapy.”
Overall, the mesothelioma patients in the second, later group had significantly better survival rates than those who were treated before 1999. The authors postulate that this is most likely due to their more advanced diagnostic and treatment modalities, including PET scanning and EPP, and “accumulated experience in a specialist treatment center”. The median survival for patient selected for EPP was 20 months, as compared to 9 month for those who had the less radical pleurodesis with decortication.
Yan, TD et al, “Improving survival results after surgical management of malignant pleural mesothelioma: an Australian institution experience”, June 2011, Annals of Thoracic and Cardiovascular Surgery, pp. 243-249.