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.

Similar Posts

Repeat HIPEC Improves Mesothelioma Survival
| |

Repeat HIPEC Improves Mesothelioma Survival

ByAlex Strauss

If one cytoreductive surgery and HIPEC procedure for mesothelioma is good, subsequent treatments may be even better. That is the central message of research conducted at the Moffitt Cancer Center in Florida. The study’s aim was to assess overall survival among peritoneal mesothelioma patients who had not just one, but two or more rounds of heated intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery. The cytoreduction/HIPEC approach has become popular for peritoneal mesothelioma, a treatment-resistant cancer of abdominal membranes caused by asbestos. Cytoreductive surgery involves removing as much of the mesothelioma tumor as possible from the abdomen. Because the shape and spreading pattern of mesothelioma tumors make complete cytoreduction difficult, the surgery is often followed by a rinse with a heated solution…

Value of Mesothelioma Surgery Challenged for Healthy Patients
| |

Value of Mesothelioma Surgery Challenged for Healthy Patients

ByAlex Strauss

New research conducted in Italy and presented at the 15th World Conference on Lung Cancer in Sydney, Australia suggests that mesothelioma surgery – no matter what kind – may not offer a survival advantage over medical management for the healthiest of patients. Mesothelioma is a rare but aggressive malignancy that is highly resistant to standard cancer treatments. The two types of mesothelioma surgery considered to be options for people with resectable cancer are pleurectomy decortication (P/D) or extrapleural pneumonectomy (EPP). While EPP is more radical than P/D because it involves removing a lung, both carry a heavy risk of complications and, according to the Italian researchers, may not be of value for certain patients. The study reviewed data from 1,365…

Mesothelioma Surgery May Have Added Benefit
| |

Mesothelioma Surgery May Have Added Benefit

ByAlex Strauss

Cancer researchers at Wake Forest University have found another benefit to the cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) combination used to treat peritoneal mesothelioma and other abdominal cancers: the control of fluid buildup. Fluid accumulation in the abdomen because of peritoneal mesothelioma or another type of cancer is known as ascites. Left untreated, ascites can cause bloating, discomfort, disfiguration, and shortness of breath when it interferes with the movement of the diaphragm. While patients with peritoneal mesothelioma, an aggressive cancer of the peritoneal surface, can have this fluid drained off, it often reaccumulates. But the new Wake Forest research suggests that CRS/HIPEC may offer a more permanent solution. Fifteen percent of the cancer patients in the study had…

P/D for Mesothelioma: Are the Studies Accurate?
| |

P/D for Mesothelioma: Are the Studies Accurate?

ByAlex Strauss

A new analysis of pleurectomy/decortication suggests that the most radical form of the surgery produces the best results for mesothelioma patients, but also carries the greatest risk. Pleurectomy/decortication or P/D involves the removal of the pleural lining where malignant mesothelioma grows. Removing all or part of the lining frees up the lungs to expand again, relieving life-limited mesothelioma symptoms such as shortness of breath. But, as the Australian researchers found in their mesothelioma analysis, the varying degrees of P/D can make it difficult to accurately compare the method to the more extensive lung-removing surgery or even to get an accurate picture of P/D outcomes. Extended or ‘radical’ P/D involves removing the entire pleural lining, while partial P/D involves removing only part…

Mesothelioma Study Cites Risks & Benefits of Second Surgery
| |

Mesothelioma Study Cites Risks & Benefits of Second Surgery

ByAlex Strauss

Peritoneal mesothelioma patients who have cytoreductive surgery (CRS) and heated chemotherapy can sometimes benefit from a second surgery, but it may be harder the second time around. Researchers in France have recently published their findings in a study of patients with mesothelioma and other peritoneal cancers who experienced recurrence after  cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Peritoneal mesothelioma is an asbestos-related malignancy that spreads across the peritoneum, the membrane that lines the abdomen. For patients who are healthy enough to undergo it, cytoreductive surgery to remove as much of the cancer as possible, followed by a solution of heated chemotherapy drugs, has been shown to improve survival. But the French team wanted to examine the possible options for people…

Mesothelioma Report Suggests Clinical Trials Better Than Surgery
| |

Mesothelioma Report Suggests Clinical Trials Better Than Surgery

ByAlex Strauss

Doctors in the Department of Respiratory medicine at York Teaching Hospital in the UK are taking a hard stance against the surgical treatment of malignant pleural mesothelioma. In a recent article in the journal Thorax, the group contends that the research surrounding mesothelioma surgery is largely flawed and that the majority of mesothelioma patients would be better served if their doctors suggested alternatives. “Belief that the modest survival times reported after radical surgery, whether alone or as part of multimodal therapy, are longer than they would have been without surgery relies on data from highly selected, uncontrolled, retrospectively analyzed case series,” they write. They point out that the only randomized study, the Mesothelioma and Radical Surgery (MARS) trial showed no measurable…