Patients with non-epithelial mesothelioma and lymph node involvement are poor candidates for the extensive surgical procedure known as extrapleural pneumonectomy (EPP), according to a new study.
That’s the finding of a new article published in the Annals of Surgical Oncology. Researchers from the Baird Institute for Applied Heart and Lung Surgical Research in Sydney, Australia analyzed the current literature on EPP for malignant pleural mesothelioma. They examined the patient selection process and overall survival of surgical patients in major referral centers where EPP is performed.
The most serious of the asbestos cancers, mesothelioma tends to spread quickly and is notoriously resistant to standard treatments. Clinical trials across the globe have confirmed that the best mesothelioma outcomes are seen in patients who undergo EPP, followed by adjuvant therapies such as chemotherapy and/or radiotherapy.
In the new review article, seventeen studies from 13 institutions were found to offer the most complete and up-to-date information for analysis. The authors report that “a number of quantitative, clinical and treatment-related factors were identified to have significant impact on overall survival.”
While the researchers found marked differences in the way different institutions select mesothelioma patients for surgery, they found that, across the board, patients who had sarcomatoid or biphasic mesothelioma did not fair as well after surgery as those who had the epithelioid type. Likewise, mesothelioma patients whose cancer had spread to their lymph nodes also did not do as well after surgery as patients whose tumors were confined to the mesothelium. In their conclusion, the researchers suggest that these patients be excluded from consideration for EPP.
EPP, which involves removing not only the cancerous tissue but, often, a lung or portion of a lung, carries serious risk of complication or even death. Careful selection of mesothelioma surgical candidates, say the study’s authors, not only improves outcomes for the right patients, but protects those who are not good surgical candidates from undergoing a risky operation for limited benefit.
Sources: Cao, C et al, “Summary of Prognostic Factors and Patient Selection for Extrapleural Pneumonectomy int eh Treatment of Malignant Pleural Mesothelioma”, April 22, 2011, Annals of Surgical Oncology.