Researchers at the Icahn School of Medicine at Mount Sinai have added their voices to the ongoing debate over the best type of surgery for malignant pleural mesothelioma.
After a meta-analysis of 30-day mortality among 500 mesothelioma patients, the group has come down on the side of pleurectomy decortication (PD), the more conservative — and less risky — of the two major types of mesothelioma surgery.
Mesothelioma Surgery: EPP vs. P/D
Pleural mesothelioma, also referred to as asbestos cancer, is notoriously difficult to treat. Successful mesothelioma treatment usually involves a combination of therapies, such as Alimta (pemetrexed), radiotherapy, and curative surgery in patients who are healthy enough to undergo it. (Surgery is currently only recommended for patients with epithelioid mesothelioma, although recent research has challenged that idea.) Fewer than 1 in 5 pleural mesothelioma patients qualify for surgery.
There are two primary types of mesothelioma surgery — exrapleural pneumonectomy (EPP) and pleurectomy decortication (PD).
Surgeons worldwide continue to disagree on which type of surgery is preferrable. The late David Sugarbaker, MD, developed the EPP procedure, which involves removal of the diseased pleural lining, the closest lung, the diaphragm, the pericardium, and a number of other at-risk tissues.
Dr. Sugarbaker and his colleagues at Baylor St. Luke’s Medical Center in Houston boasted some of the best mesothelioma survival rates in the world using EPP.
However, a growing number of surgeons, including the Icahn School of Medicine group, have begun to favor the less traumatic pleurectomy decortication procedure developed by Dr. Robert Cameron at UCLA, which includes removal of the pleura and other tissues, but leaves the lungs in place.
Surgeons who favor this approach say it allows for a better quality of life for mesothelioma patients.
30-Day Mesothelioma Survival After Surgery
The newest study on the two types of mesothelioma surgery, published in the Journal of Surgical Oncology, focuses on survival odds during the critical period in the month following surgery.
They analyzed data from the New York Statewide Planning and Research Cooperative System (SPARCS) on 500 pleural mesothelioma patients who underwent either EPP or PD.
Although no difference was found in the number of complications that developed right after surgery or the number mesothelioma patients who died while still in the hospital, differences between the EPP and PD patients began to show up quickly after patients went home.
Nearly half (46%) of the EPP patients developed surgery-related complications, versus just 24% of the PD patients. One of the most significant and common complications were heart rhythm problems called arrythmias, which occurred five times as often in the EPP group (20% vs. 5%).
“Postoperative mortality, postoperative complications, and particularly supraventricular arrhythmia are less frequent after PD vs. EPP,” writes author Emanuela Taioli, MD, PhD. “PD, a less invasive surgery, may provide a better option when technically feasible for patients with malignant pleural mesothelioma.”
Van Gerwen, M, et al, “Short-term outcomes of pleurectomy decortication and extrapleural pneumonectomy in mesothelioma”, Journal of Surgical Oncology, October 7, 2018, Epub ahead of print