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Mesothelioma Surgery Debate: Experience is the Answer

ByAlex Strauss

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A pair of researchers in the UK say a cancer center’s level of experience in dealing with mesothelioma may be the most important factor in achieving good surgical outcomes – not which surgery is chosen.

Their new meta-analysis is the latest in a long line of studies attempting to discern which type of mesothelioma surgery is best for patients in terms of survival and complications. The global medical community remains sharply divided over the risks and benefits of lung-sparing pleurectomy/decortication vs. lung-removing extrapleural pneumonectomy.

In the newest study, authors Sotiris and Sayonara Papaspyros analyzed the results of 16 separate studies comparing P/D to EPP in the treatment of mesothelioma. They found a median survival range from 8.1 to 32 months with P/D while the longest median survival after EPP was 46.9 months and the shortest was 6.9.

The rate of complications with each types of mesothelioma surgery was also mixed: Complication rates ranged from as low as 5.9% with P/D and 10% with EPP to as high as 55% with P/D and 82.6% with EPP. The highest median mortality for P/D among the studies was 9.8% while the highest with EPP was 12.5%. But there were some studies where no mesothelioma patients died from P/D while the lowest death rate found with EPP was 3.2%.

In an effort to summarize these conflicting findings, the authors conclude that either surgery is sometimes warranted that that clinical experience appears to have the biggest impact on outcomes. “This systematic review suggests that surgery in the context of trimodality therapy offers acceptable perioperative outcomes and long-term survival. Centers specializing in malignant pleural mesothelioma management have better results,” they write in ISRN Surgery.

Because of the usual shape and tricky location of mesothelioma tumors – spread across the thin pleural lining that surrounds the lungs – both types of mesothelioma surgeries are considered extremely challenging and it is usually not possible to remove all traces of mesothelioma. For this reason, most centers combine mesothelioma surgery with chemotherapy and radiation before and/or after the procedure.

Source: Papaspyros, S and Papaspyros, S, “Surgical management of malignant pleural mesothelioma: Impact of surgery on survival and quality of life-relations to chemotherapy, radiotherapy, and alternative therapies”, February 2014, ISRN Surgery, http://www.hindawi.com/journals/isrn.surgery/2014/817203/

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