Sickest Mesothelioma Patients May Benefit Most from P/D Surgery

Patients with the worst cases of malignant pleural mesothelioma may stand to gain the most from pleurectomy and decortication (P/D) surgery.

That is the conclusion of researchers at the University of Chicago and Loyola University who subjected 114 mesothelioma patients to a quality of life and overall health scoring system both before and after P/D surgery.  

Considering Mesothelioma Surgery

The decision on whether or not to undergo mesothelioma surgery and which type of surgery to have is always a difficult one.

P/D surgery is extensive and involves the removal of the diseased pleural lining around the lungs, all or part of the diaphragm, and other at-risk tissues. Although it has been shown to slow the progression of mesothelioma, P/D, like any major surgery, also has the potential to negatively impact health-related quality of life.

But in a new study published in the World Journal of Surgery, the University of Chicago researchers say P/D surgery may be more worth the risk for some patients than for others. Ironically, it may be the sickest mesothelioma patients who see the most benefit.

Mesothelioma Surgery Study Design

To assess the impact of surgery on their quality of life, mesothelioma patients completed surveys and health assessments at baseline (prior to surgery) and at 1, 4-5, 7-8, and 10-11 months after surgery.

As expected, patients with a good performance status (a measure of overall health), those with the epithelioid variety of mesothelioma, and those whose tumors were relatively small had the fewest symptoms prior to surgery.

These patients reported feeling worse in the first month after surgery than they did before it, although their health gradually improved over time.

But for patients with the even-more-virulent non-epithelioid varieties of mesothelioma and those with large tumors, the opposite was true.

“Non-epithelioid histology and patients with large pathological tumor volume demonstrated greater improvement in global health, function and symptoms domains following pleurectomy with decortication,” writes internationally-known cardiothoracic surgeon and lead researcher, Wickii Vigneswaran, MD, of Loyola University Medical Center.

These two groups of mesothelioma patients also continued to see the greatest improvement in their overall health and quality of life in the months following surgery.

More Support for P/D Mesothelioma Surgery

Earlier this year, a team of researchers with Hofstra and Mount Sinai Universities in New York concluded that, regardless of mesothelioma type, P/D was the surgical approach most likely to result in improved quality of life.

That study analyzed 15 articles including 523 patients to compare P/D to the more radical lung-removing EPP surgery. They concluded that quality of life should be “strongly considered” when choosing a surgical approach for mesothelioma.

According to the researchers, about 22 percent of malignant pleural mesothelioma patients undergo some type of surgery, which has also been found to be an independent predictor of extended mesothelioma survival.

Sources:

Vigneswaran, WT, et al, “Influence of Pleurectomy and Decortication in Health-Related Quality of Life Among Patients with Malignant Pleural Mesothelioma”, September 25, 2017, World Journal of Surgery, Epub ahead of print

Schwartz, R, et al, “The impact of surgical approach on quality of life for pleural malignant mesothelioma, June 2017, Annals of Translational Medicine, pp. 230