Lung-Sparing Surgery and Mesothelioma Survival

When it comes to the mesothelioma surgery known as pleurectomy/decortication (P/D), not all techniques are created equal.

A new report in the European Journal of Cardio-Thoracic Surgery finds that two of the three primary P/D approaches offer a significant mesothelioma survival advantage over the third.

Setting up the Mesothelioma Surgery Study

Thoracic surgeons from 11 Italian institutions reviewed the cases of 314 pleural mesothelioma patients who had P/D surgery to remove the pleural membrane and certain other at-risk tissues between January 2011 and October 2014.

The characteristics of the study participants were in line with worldwide mesothelioma statistics. There were almost four times as many male mesothelioma patients as there were female, most had the epithelioid type of the mesothelioma and the median age at the time of operation was 67.8.

Sixty-two percent of patients were diagnosed with Stage III mesothelioma. Fifty-seven percent of the mesothelioma patients received chemotherapy prior to P/D surgery.

Three Types of P/D Surgery for Mesothelioma

Mesothelioma surgeries fall into two broad categories – extrapleural pneumonectomy (EPP), which includes the removal of the diseased lung, and P/D, which removes the pleura but leaves the lungs in place.

Although many mesothelioma experts are now favoring P/D over EPP because of its lower risk of complications and death, the two approaches are hard to compare side-by-side because there are multiple ways to perform P/D.

In the new Italian study, the researchers attempted to compare the three primary P/D approaches: extended P/D/, P/D, and partial P/D.

One hundred and sixty-two of the study participants underwent extended P/D (also known as radical P/D) which includes removal of the pleura, the pericardium around the heart. and the diaphragm as well as other tissues.

Another 115 pleural mesothelioma patients underwent a standard P/D surgery which leaves more tissues in place. Just 37 patients (11.8%) had partial P/D which involves removal of the pleura but does not attempt to remove all of the tumor tissue.

Mesothelioma Survival After P/D Surgery

After analyzing the results, the researchers concluded that only P/D and extended P/D impacted mesothelioma survival.

“Whether the P/D is extended or not, it shows similarly good outcomes in terms of early results and survival rate,” writes study author Giuseppe Marulli of the University of Padova. “In contrast, a partial pleurectomy, which leave gross tumour behind, has no impact on survival.”

While partial P/D may not extend survival, it may still have a role to play in mesothelioma treatment. The MesoVATS trial, a multicenter study that included 175 patients with malignant pleural mesothelioma and pleural effusions, found that partial pleurectomy significantly improved patients’ quality of life by effectively controlling their excess lung fluid.

Source:

Marulli, G, et al, “Pleurectomy–decortication in malignant pleural mesothelioma: are different surgical techniques associated with different outcomes? Results from a multicentre study”, April 12, 2017, European Journal of Cardio-Thoracic Surgery, Epub ahead of print