Yet another new study appears to support the idea that lung sparing pleurectomy/decortication surgery should be the preferred surgical approach for patients with malignant pleural mesothelioma.
Researchers in the UK and Italy have recently published data on 362 mesothelioma patients undergoing either extended P/D or the more radical lung-removing extrapleural pneumonectomy between 1999 and 2014.
Their goal was to determine what effect a medical center’s transition from EPP to extended P/D would have on mesothelioma outcomes.
History of Mesothelioma Surgery
For many years, lung-removing EPP surgery was the preferred approach for optimizing mesothelioma survival in both the UK and the US.
But new studies in recent years have cast doubt on the effectiveness of this approach since it carries such a high risk for complications and even death. The loss of a lung can also negatively impact quality of life.
Many practices, including the two hospitals represented in the new study in the European Journal of Cardiothoracic Surgery, have transitioned to the more conservative lung-sparing approach in an effort to minimize complications and improve mesothelioma survival.
Results of New Surgery Study
According to the new report, there were differences in the mesothelioma patients treated with EPP and those treated with P/D in these centers.
Patients who were selected to undergo the more conservative mesothelioma surgery tended to be both older (a median of 65 vs 57) and sicker than those who underwent EPP.
Despite these differences, there was no different in the median length of hospital stay between the groups or in the 30- or 90-day mortality of the mesothelioma patients.
More importantly, there was also no difference in mesothelioma survival.
“There was no significant difference in overall survival or disease-free interval between the two groups,” reports study author Annabel Sharkey with the University of Leicester in the UK. “However, overall survival was significantly greater in patients over the age of 65 undergoing extended pleurectomy/decortication.”
Mesothelioma Treatment Options
Surgery is just one of the approaches used in mesothelioma treatment.
Most patients with mesothelioma will be treated with a combination of several therapies, which may also include chemotherapy, radiation, and experimental treatments such as immunotherapy.
The optimal combination of therapies and the order in which these different therapies should be used in the treatment of mesothelioma are the subjects of intense mesothelioma research around the world.
Sharkey, AJ, et al “The effects of an intentional transition from extrapleural pneumonectomy to extended pleurectomy/decortication”, December 3, 2015, European Journal of Cardiothoracic Surgery, Epub ahead of print,