New Studies Question Radical Mesothelioma Surgery

Calling it “a harmful procedure” a team of Italian surgeons is recommending against a controversial and radical type of surgery for early-stage mesothelioma.

Mesothelioma is a rare but virulent cancer that starts in the membrane that encases the lungs or other organs. As mesothelioma spreads, it can metastasize into the lungs and other parts of the chest cavity. Extrapleural Pneumonectomy (EPP) is an extensive surgery that involves not only removal of the cancerous pleural lining, but also the lung closest to it, the membranes around other organs, and all or part of the diaphragm. It carries a high risk of complication and death, prompting many of the world’s top mesothelioma experts to reject it completely.

In the latest study of the procedure, published in the journal Lung Cancer, the Italian research team compared long-term post-operative quality of life as well as disease control among mesothelioma patients who had EPP with those who underwent a less radical procedure called pleurectomy/decortication (PD). Thirty-nine early stage mesothelioma patients who had had either EPP (19) or PD (20) were asked to complete the EORTC-QLQ quality of life questionnaire at baseline and again at 6 and 12 months post-treatment.

Sixty-two percent of EPP patients experienced major complications in the hospital, compared to 24% of PD patients. There were two deaths after surgery among the EPP patients and none among those who had PD. Both procedures caused a “significant impairment” of all the variables on the questionnaire but only the PD patients returned to their baseline levels after 12 months. Overall, EPP patients had a worse long-term post-operative quality of life compared with the PD patients. The difference in long-term survival (25 months for EPP, 20 months for PD) was not large enough to be statistically significant.

Although many top mesothelioma centers still consider EPP to be the best surgical option for advanced disease, a recent study from England contradicts that opinion, too. In their study of 165 mesothelioma patients, the English research team found fewer post-surgical deaths and complications but comparable survival rates, among patients who had lung-sparing surgery, compared to those who had EPP.

The researchers concluded that malignant pleural mesothelioma patients submitted to EPP had a “higher post-operative complication rate, a worse long-term Quality of Life, a shorter residual life time after recurrent disease, despite a similar long-term survival when compared to P/D.

Results were based on a single institution. Other studies suggest that institutions that specialize in using EPP to treat mesothelioma can have better results.

Sources:

Rena, O, Casadio, C, “Extrapleural pneumonectomy for early stage malignant pleural mesothelioma: A harmful procedure”, January 11, 2012, Lung Cancer, Epub ahead of print. Nakas, A et al, “Long-term survival after lung-sparing total pleurectomy for locally advanced (International Mesothelioma Interest Group Stage T3-T4) non-sarcomatoid malignant pleural mesothelioma”, December 16, 2011, European Journal of Cardiothoracic Surgery, Epub ahead of print.