The largest analysis of mesothelioma surgery ever done finds little survival difference between lung-sparing and lung-removing surgeries.
A team of top mesothelioma oncologists and surgeons at three US Universities analyzed the cases of 1,307 malignant mesothelioma patients from the National Cancer Database (NCDB), a joint project of the American College of Surgeons and the American Cancer Society.
After using a series of statistical tools to analyze the data, the researchers concluded that, in terms of mortality, hospital readmission rates, and mesothelioma survival, extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) were almost evenly matched.
“Median overall survival in the EPP and P/D groups was 19 versus 16 months; no differences were observed after propensity-matching,” writes Vivek Verma, MD, a radiation oncology resident at the University of Nebraska Medical Center in Omaha in the Journal of Thoracic Oncology. “There were no differences between cohorts in 30-day readmission or mortality.”
EPP versus P/D for Mesothelioma Treatment
There has been considerable debate among mesothelioma experts in recent years over which types of mesothelioma surgery is most effective.
EPP is the most radical type of mesothelioma surgery because it involves not only removing the diseased pleural lining where the mesothelioma tumor started, but also the nearest lung. P/D also involves removal of the diseased pleura, all or part of the diaphragm, and other at-risk tissues, but leaves both lungs in place.
A number of studies have suggested that, although EPP carries a higher rate of complications and results in a lower post-surgical quality of life, it may offer a modest mesothelioma survival advantage over P/D.
But the current, larger study appears to refute those findings, suggesting instead that, all things being equal, there is little advantage to one surgery over another.
Mesothelioma Surgery: Demographics Matter
P/D was considerably more common than EPP, having been used in about 79% of the mesothelioma patients as opposed to 21% who had EPP. There were also significant differences in the demographics and even the geographics of mesothelioma patients who had one of the two types of surgeries.
For instance, patients who had the less radical P/D surgery tended to be older than those undergoing EPP, whereas patients who had EPP were more likely to live in a rural area.
Mesothelioma patients who had EPP were also more likely to live further from their treatment facility and that facility was more likely to be part of an academic center.
The bottom line for mesothelioma patients and their families is that the experience of their surgeon and their proximity to an academic center may be the most critical considerations in deciding which type of mesothelioma surgery to have.
“Procedure type was influenced by sociodemographic and geographical factors, without observed differences in survival or postoperative mortality/readmission rates between techniques,” concludes the report.
Verma, V, et al, “National Cancer Data Base Report on Pneumonectomy Versus Lung-Sparing Surgery for Malignant Pleural Mesothelioma”, August 23, 2017, Journal of Thoracic Oncology, Epub ahead of print