It is not always possible to predict which patients will suffer from mesothelioma surgery complications. But a new study suggests there is way to make an educated guess about one particular kind of complication.
A lung-removing operation called EPP used to be the preferred surgery for pleural mesothelioma. Most surgeons now favor a more conservative procedure called P/D.
But surgeries do not always work out the way patients and surgeons hope they will. In some cases, mesothelioma surgery complications require the surgeon to convert a planned P/D procedure into an EPP operation instead.
A team of Japanese researchers recently analyzed which patients had the highest risk for these mesothelioma surgery complications and what kinds of outcomes they experienced.
Converting P/D to EPP
P/D stands for pleurectomy with decortication. During this mesothelioma operation, the surgeon removes the diseased pleural membrane around the lungs. Other at-risk tissues in the chest may also be removed. Surgeons scrape the surface of the lungs to remove as many mesothelioma cells as possible.
Extrapleural pneumonectomy (EPP) takes this a step further. Surgeons not only remove the pleura, all or part of the diaphragm, and other at-risk tissues, but they also remove the affected lung. Mesothelioma surgery complications are more common with EPP. But some studies suggest that it may improve mesothelioma survival.
Doctors do their best to determine which type of surgery is best for which patient. But certain mesothelioma surgery complications can arise during the operation. If mesothelioma cells have invaded a lung or if it is not possible to scrape them off effectively (decortication), surgeons may decide to convert a P/D surgery into an EPP surgery.
Predicting Mesothelioma Surgery Complications
Researchers with Hyogo College of Medicine analyzed the cases of 181 pleural mesothelioma patients. The patients were slated to have P/D surgery between 2012 and 2019. But about 10 percent of them ran into mesothelioma surgery complications that required their surgeons to switch to EPP.
Among the patients who ended up having EPP, all had thicker pleural membranes and a more advanced T stage of their cancer. (The “T” in the TNM Staging system refers to volume of the primary tumor.)
Unfortunately, patients with mesothelioma surgery complications who were switched from P/D to EPP did not live as long as the P/D patients. The median overall survival was 29.2 months among the converted cases versus 57 months among the P/D patients. The EPP group also experienced a shorter remission.
“Preoperative pleural thickness and clinical T stage may be risk factors associated with conversion to EPP,” concludes lead author Akifumi Nakamura. “The survival rate of conversion to EPP was worse than that of P/D.”
Patients considering either type of mesothelioma surgery should seek out an experienced medical center. Experienced centers have lower rates of mesothelioma surgery complications and better overall mesothelioma outcomes.
Nakamura, A, et al, “Outcomes of Conversion to Extrapleural Pneumonectomy From Pleurectomy/Decortication for Malignant Pleural Mesothelioma”, February 18, 2021, Seminars in Thoracic and Cardiovascular Surgery, Online ahead of print, https://linkinghub.elsevier.com/retrieve/pii/S104306792100023X