New research out of Italy casts another vote in favor of the controversial and radical surgical approach known as extrapleural pneumonectomy (EPP) for treating mesothelioma.
Pleural mesothelioma occurs in the pleural membrane which separated the lungs from other internal organs. As the cancer spreads, it restricts the ability of the lungs to expand. Eventually, pleural mesothelioma can spread into the lungs themselves and other internal membranes. Extrapleural pneumonectomy attempts to prevent metastasis by removing the tissues most likely to be effected, including the lung lining, part of the pericardium (lining around the heart), a portion of the diaphragm, and the diseased lung.
Because EPP is so radical and so risky (it carries a 60 percent complication rate), many of the world’s top mesothelioma experts advise against it in favor of less radical ‘lung sparing’ approaches. But a team of researchers in the Department of Thoracic Surgery at Tor Vergata University in Rome say their study shows the approach has merit for some patients, not only for its impact on survival but also for its potential to improve quality of life in a patient’s remaining months or years.
In an evaluation of 29 consecutive mesothelioma patients treated with EPP between 1997 and 2007, only one died immediately after surgery. Although many mesothelioma patients do not survive beyond a year, median survival of EPP patients in the Italian study was 19.5 months, with 17 patients still alive at 1 year and 10 still alive at 2 years. At 3 months post surgery, all measures of physical and emotional health, including arterial blood gas, a 6-minute walk test, cardiac fraction ejection, pain, shortness of breath, cough, performance status, weight loss, activity and mood improved.
At 12 months post surgery, the team reports that “the amelioration of pain, dyspnea (shortness of breath), performance status and physical-related quality of life parameters remained stable.” After a year, all of these parameters began to deteriorate and all mesothelioma survivors reported a return of pain and dyspnea after 24 months.
“Extrapleural pneumonectomy has a significant and durable impact on function and symptoms as well as on physical and mental components of quality of life in patients with malignant pleural mesothelioma,” conclude the researchers in a report of their findings in the Annals of Surgical Oncology.
Previous studies have found that patients whose mesothelioma is caught in its earliest stages, while the cancer is still contained in a fairly small area and is easily resectable, make the best candidates for EPP surgery. Patients diagnosed with the epithelioid variety of mesothelioma, rather than those whose cancer cells are determined to be of the sarcomatoid or biphasic varieties, also tend to respond best to extrapleural pneumonectomy.
Ambrogi, V et al, “Clinical Impact of Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma”, December 23, 2011, Annals of Surgical Oncology, Epub ahead of print. Argote-Green, Luis et al, “Extrapleural pneumonectomy for malignant pleural mesothelioma”, Journal of Cardiothoracic Surgery online, Multimedia Manual of Cardiothoracic Surgery, June 28, 2005.