The two major types of mesothelioma surgeries carry similar risk of death, according to a new study from cancer researchers in Japan.
One surgery involves removing the diseased pleural lining and one of the lungs. The other surgery removes many of the same tissues but leaves the lungs intact.
Surgeons around the world are divided as to which of these mesothelioma surgeries is best. Mesothelioma patients have more complications with lung-removing surgery. But some studies suggest it could lead to longer survival.
The 4-year Japanese study included more than 600 patients. It suggests that the likelihood of dying is similar with either of these mesothelioma surgeries.
Surgical Treatment of Pleural Mesothelioma
Pleural mesothelioma is the most common type of asbestos cancer. It occurs on the lining around the lungs called the pleura.
Extrapleural pneumonectomy (EPP) is a procedure in which surgeons remove mesothelioma tumors and other tissues in the chest. This includes the lung closest to the tumor. EPP is the more radical of the two primary mesothelioma surgeries. It can take a long time to recover from EPP.
Pleurectomy/decortication (P/D) is the other major type of surgery for pleural mesothelioma. During P/D, surgeons remove many of the same tissues as EPP. But they do not remove a lung. Patients tend to recover faster and have fewer complications after P/D.
Both types of mesothelioma surgeries require a high level of surgical expertise. They are usually reserved for patients who are in overall good health.
Comparing Mesothelioma Surgeries
The Japanese study included 622 pleural mesothelioma patients in the National Clinical Database. The patients had surgery between 2014 and 2017. Researchers analyzed surgical outcomes, risk factors, and complications between the two types of mesothelioma surgeries.
A total of 279 patients had EPP. P/D was performed on 343 patients. EPP was more common in centers that did not see a lot of cases of malignant mesothelioma. P/D was preferred in centers that treated more than 10 cases during that four-year period.
Forty-five percent of EPP patients had complications after their mesothelioma surgeries. That rate was about 36% among the P/D patients.
“Heart failure and pneumonia were most frequent in EPP, while prolonged air leakage was most frequent in P/D,” writes study author Masaki Hashimoto of Hyogo College of Medicine.
But the length of time surgery patients stayed in the hospital and the number of patients who died within thirty days were nearly identical between the two groups. Just over three percent (3.2%) of patients died in the hospital. Only about one percent of patients died within 30 days.
People over 65 had the most complications after EPP. There were no risk factors for complications among those who had P/D. The researchers conclude that the risk of death from mesothelioma surgeries is low, especially when patients get care in experienced centers.
Hashimoto, M, et al, “Japanese Current Status of Curative-Intent Surgery for Malignant Pleural Mesothelioma”, April 27, 2021, Annals of Thoracic Surgery, Online ahead of print, https://linkinghub.elsevier.com/retrieve/pii/S0003497521007542