Extrapleural pneumonectomy is the more radical of the two surgeries and involves the removal of a lung along with the diseased pleural lining where mesothelioma tumors start, all or part of the diaphragm, the lining around the heart, and other at-risk tissues. While the complication rate is higher with EPP, some studies have suggested that the surgery may improve the odds of surviving mesothelioma.
Pleurectomy/decortication involves the removal of the pleura and many of the same tissues, but leaves the lungs intact. Studies suggest that patients tend to recover from this type of surgery faster. Both types of procedures may be preceded or followed by chemotherapy or radiation to shrink mesothelioma tumors for easier removal or to kill residual cancer cells.
Doctors around the world are deeply divided over which type of surgery gives mesothelioma patients the best odds of survival. The newest study, conducted by doctors at the Hofstra North Shore-LIJ School of Medicine and Mount Sinai Health System, is a meta-analysis its authors say is designed to answer the question once and for all.
The researchers included original research studies that evaluated long-term outcomes of 1,513 mesothelioma patients who underwent P/D and 1,391 patients who had EPP. The studies were all published between 1990 and 2014. Researchers calculated the number of patients who died in each group, either right around the time of surgery or within the two years following surgery.
Summarizing the findings in the Annals of Thoracic Surgery, lead author Emanuela Taioli, MD, PhD, concludes, “The reanalysis of the large number of studies comparing P/D to EPP suggests that P/D is associated with a 2 ½-fold lower short-term mortality (perioperatively and within 30 days) than EPP. Pleurectomy decortication should therefore be preferred when technically feasible.”
A number of factors are considered when determining which type of mesothelioma surgery is best for any given patient, including the patient’s age, cancer stage, overall health and co-existing conditions. Outcomes tend to be better in centers that perform the highest number of mesothelioma surgeries.
Taioli, E et al, “Meta-Analysis of Survival After Pleurectomy Decortication Versus Extrapleural Pneumonectomy in Mesothelioma”, December 20, 2014, Annals of Thoracic Surgery, Epub ahead of print