Lung-Sparing Surgery for Mesothelioma Superior to EPP, Study Says

A team of Japanese researchers have added their voices to the ongoing debate over lung-sparing surgery for mesothelioma.

The researchers analyzed multiple studies on the different kinds of surgery for mesothelioma. The studies included more than 2,600 mesothelioma patients. 

After a careful review of the data, the Japanese team concluded that lung-sparing surgery for mesothelioma is almost always better than removing a lung. Mesothelioma patients who had this type of surgery had much fewer complications. They lived just as long as those who had more radical mesothelioma surgery. 

Radical and Conservative Mesothelioma Surgery

Malignant mesothelioma is a membrane cancer caused by asbestos exposure. It usually occurs in the membrane around the lungs. About 20 percent of cases occur on the membrane around the abdominal organs. 

Both lung-removing and lung-sparing mesothelioma surgery can improve survival. But surgery is not an option for every patient. The shape and location of mesothelioma tumors in the chest can make surgery difficult or even impossible. Most mesothelioma patients are over 60. Many are not healthy enough to undergo such a major procedure. 

For those who are surgery candidates, there are two major choices. The first option is extrapleural pneumonectomy (EPP). EPP removes the mesothelioma tumor, other tissues, and the closest lung. EPP carries a high risk for complications and death. But some argue that it offers the best chance of survival because it removes more cancer.

The second option is lung-sparing mesothelioma surgery. This type of surgery is called pleurectomy with decortication (PD). PD is also a major surgery but it leaves the lungs in place. As a result, it carries a lower risk for major complications than EPP.. 

Most major cancer centers prefer one or the other of these surgical approaches.

EPP versus Lung-Sparing Approach

The Japanese review found 15 studies on mesothelioma surgery. The studies include 2,674 pleural mesothelioma patients. About 1,400 of the patients had EPP surgery. The rest had lung-sparing surgery for mesothelioma.

“Our systematic review showed that lung-sparing surgery was significantly superior to lung-sacrificing surgery in both the surgical-related mortality and morbidity,” writes lead author Yoshinobu Ichiki. “Lung-sparing surgery was not inferior to EPP in terms of median survival time.”

Fewer than 10 percent of PD patients had major complications versus more than 20 percent of the EPP patients. More than seven percent of patients died from EPP surgery. Among those who had lung-sparing surgery for mesothelioma, the death rate was less than two percent. 

It is not easy to study mesothelioma because it is so rare. It is also hard to compare these two surgeries because there is no standard way to do them. Some surgeons have better training and more experience than others. No one has ever run a randomized study to directly compare the two.

Even so, the Japanese research team says lung-sparing surgery for mesothelioma should be the new standard.

“Although no prospective randomized controlled trial has been conducted, it may be time to change the standard surgical method for MPM from lung-sacrificing surgery to lung-sparing surgery,” they conclude.

Source:

Ichiki, Y, et al, “Should Lung-Sparing Surgery Be the Standard Procedure for Malignant Pleural Mesothelioma?”, July 8, 2020, Journal of Clinical Medicine, https://www.mdpi.com/2077-0383/9/7/2153