Mesothelioma Surgery Under Fire Again

The group that stirred worldwide debate among medical specialists last year with their stance against a radical mesothelioma surgery is taking up the controversial topic once again.

Led by prominent Los Angeles-based mesothelioma doctor Robert Cameron, MD, Director of the UCLA Mesothelioma Comprehensive Research Program, the group includes experts from San Francisco, New York and as far away as South Africa. In addition to an interest in the rare asbestos-linked cancer mesothelioma, these experts share a common dislike for extrapleural pneumonectomy (EPP), a major surgical procedure that is still considered by some to be the ‘gold standard’ surgical treatment for this disease.

Introduced in the 1940’s and modified over the years, EPP is a mesothelioma surgery that involves removal of not only the diseased pleural tissue, but the lung closest to it, the lymph nodes, portions of the covering of the heart (pericardium) and all or part of the diaphragm. Despite a 60 percent complication rate, the radical surgical approach has been shown in some studies to improve survival, especially when combined with adjuvant therapies like chemotherapy and/or radiation. Among its proponents is prominent mesothelioma researcher and surgeon Dr. David Sugarbaker of Brigham and Women’s Hospital in Boston.

But lung-sparing advocates say the possibility of a positive outcome with EPP is not worth the pain, risk, and potentially life-altering side effects to mesothelioma patients. At their first annual international symposium last year, the group reviewed a large UK study of EPP and unanimously concluded that the procedure should be abandoned.

“Clearly, it is best for the patient to treat mesothelioma as a chronic illness while preserving the function of both lungs,” Dr. Cameron said in a press release announcing the upcoming conference.

Instead of EPP, Dr. Cameron and his seminar colleagues advocate lung-sparing techniques such a pleurectomy/decortication (PD), which involves removing only the diseased pleura and aggressively treating the remaining mesothelioma with other therapies. But the recommendation remains controversial, especially in light of new studies, such as one just concluded in Leicester, UK, that finds no survival difference between EPP and Lung-sparing Total Pleurectomy (LSTP). Like other studies, this one suggests that EPP outcomes depend largely on the experience of the center where it is performed and careful mesothelioma patient selection.

This year’s International Symposium on Lung-Sparing Therapies for Malignant Pleural Mesothelioma is scheduled for May 12th in Santa Monica, California.

Sources:

“Mesothelioma Experts to Meet for 2nd International Symposium on Lung-Sparing Therapies for Malignant Pleural Mesothelioma May 12th”, February 21, 2012, Pacific Meso Center press release, PR Newswire. Nakas, A, “The new case for certvial mediastinoscopy in selection for radical surgery for malignant pleural mesothelioma”, January 28, 2012, European Journal of Cariothoracic Surgery, Epub ahead of print.