Navigating Surgical Resection for Pleural Mesothelioma: Insights from Expert Commentary

ByHolly Zink
Navigating Surgical Resection for Pleural Mesothelioma: Insights from Expert Commentary

Valerie Rusch, MD, from Memorial Sloan Kettering Cancer Center, has released a new opinion commentary. It examines the evolution of surgical resection for pleural mesothelioma in light of changing treatments and patient selection.

Historical Perspective: From Mainstay to Multimodality Therapy

Dr. Rusch notes that in the past, surgery was key for treating pleural mesothelioma without effective drugs. Then, in 2003, chemotherapy with cisplatin and pemetrexed emerged. This marked a shift to using multiple treatments, challenging surgery’s dominance.

The article discusses important moments in treating pleural mesothelioma. For example, it covers how pleurectomy decortication or extrapleural pneumonectomy became more popular once they showed better survival rates. Then, immune checkpoint inhibitors in 2021 shook things up, sparking debates about the need for surgery.

Insights from Recent Research: Patient Selection and Surgical Outcomes

Dr. Rusch reviews the MARS2 trial. It compared adding extended pleurectomy and decortication to standard chemo before surgery in pleural mesothelioma. The trial found no increase in 5-year survival with extended pleurectomy with decortication. However, it raised concerns about cost and quality of life after surgery. This led to a reevaluation of surgery’s role.

Another study, like the one by Nakamura et al., showed the benefits of surgery after initial chemo. Dr. Rusch stresses the need for careful patient selection and standard surgical methods to improve outcomes.

The commentary also discusses updating staging systems and considering more factors for prognosis. This could lead to better patient selection. Dr. Rusch emphasizes the importance of personalized treatments based on patient and hospital specifics.

Dr. Rusch’s advice helps doctors in the area of mesothelioma surgery. It focuses on significant advances, the latest research, and future steps. This underscores the value of tailored treatments and thorough pre- and post-surgery care.

Source:

Rusch, Valerie W. “Surgical Resection for Pleural Mesothelioma: Is It All about Patient Selection?” The Annals of Thoracic Surgery, April 6, 2024. https://doi.org/10.1016/j.athoracsur.2024.03.026.

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