Surgical Intervention in Pleural Mesothelioma: A Key to Improved Survival

ByHolly Zink
Surgical Intervention in Pleural Mesothelioma: A Key to Improved Survival

Pleural mesothelioma is a rare, aggressive cancer with a poor prognosis. The impact of surgery on mesothelioma patient survival is unclear and sparking debate.

A recent study was presented at the World Conference on Lung Cancer. It checked the survival of pleural mesothelioma. Some patients had chemotherapy treatments followed by surgery, while other patients skipped surgery. The aim of the study was to see if surgery could help mesothelioma patients live longer.

The Impact of Surgery on Survival

There are a variety of surgical procedures and treatments for pleural mesothelioma. The most recent study, from January 2011 to December 2021, included 296 patients. All were eligible for surgery after three cycles of chemotherapy with platinum plus pemetrexed.

Among them, 272 had the surgery, while 24 refused. Those who had surgery underwent various procedures. These included pleurectomy/decortication, extrapleural pneumonectomy, and exploratory thoracotomy. Those who refused surgery were medically fit but chose not to proceed.

The study found significantly better survival rates in the surgery group. Their median survival was 40.7 months, compared to 23.6 months for the non-surgery group. Similarly, the surgery group’s median survival without progression was 20.2 months, versus 12.9 months for the non-surgery group.

These differences were statistically significant, suggesting surgery improves survival for mesothelioma patients.

Surgery in Multimodal Treatment

The study highlights the importance of surgery for mesothelioma. Surgery aims to remove as much cancer as possible, and it may be part of a treatment plan that includes other therapies.

Doctors often perform cytoreductive surgery in combination with other mesothelioma treatments such as chemotherapy. For example, in a HIPEC procedure (heated intraperitoneal chemotherapy), surgeons introduce heated chemotherapy directly into the surgical cavity. In the peer reviewed medical literature, HIPEC procedures used in peritoneal mesothelioma management report superior survival statistics when compared to other surgeries.

Immune checkpoint inhibitors also show promise for advanced mesothelioma. But, early cases rely on surgery, chemotherapy, and radiotherapy. Past studies suggest surgery with chemotherapy can extend mesothelioma patients’ lives.

The latest research shows that surgery can improve survival in mesothelioma patients. While further research is needed to confirm these findings, this study adds to the growing body of evidence supporting the role of surgery in the multimodal treatment of pleural mesothelioma.

Source:

Rusch, Valerie W. “Surgical Resection for Pleural Mesothelioma: Is It All about Patient Selection?” The Annals of Thoracic Surgery, April 6, 2024. https://doi.org/10.1016/j.athoracsur.2024.03.026.

Similar Posts

Doctors Describe "Concrete Therapeutic Approach" for Mesothelioma
| |

Doctors Describe "Concrete Therapeutic Approach" for Mesothelioma

ByAlex Strauss

A team of medical researchers in Italy have achieved what they are calling “excellent” tumor control and survival results in malignant pleural mesothelioma patients using a combination of surgery, chemotherapy, and radiotherapy. Caused by exposure to asbestos, mesothelioma typically spreads quickly across the lung-encasing membrane called the pleura. There is no known cure but treatments are improving. In the current prospective study, 20 malignant pleural mesothelioma patients underwent radical pleurectomy/decortication followed by high doses of radiation. After surgeons removed as much of the visible mesothelioma tumor and surrounding tissue as possible, patients received 50Gy of radiation to the effected side of their chest, delivered in 25 fractions. Regions of particular concern for mesothelioma regrowth got an extra radiation “boost” to…

Repeat HIPEC Improves Mesothelioma Survival
| |

Repeat HIPEC Improves Mesothelioma Survival

ByAlex Strauss

If one cytoreductive surgery and HIPEC procedure for mesothelioma is good, subsequent treatments may be even better. That is the central message of research conducted at the Moffitt Cancer Center in Florida. The study’s aim was to assess overall survival among peritoneal mesothelioma patients who had not just one, but two or more rounds of heated intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery. The cytoreduction/HIPEC approach has become popular for peritoneal mesothelioma, a treatment-resistant cancer of abdominal membranes caused by asbestos. Cytoreductive surgery involves removing as much of the mesothelioma tumor as possible from the abdomen. Because the shape and spreading pattern of mesothelioma tumors make complete cytoreduction difficult, the surgery is often followed by a rinse with a heated solution…

Value of Mesothelioma Surgery Challenged for Healthy Patients
| |

Value of Mesothelioma Surgery Challenged for Healthy Patients

ByAlex Strauss

New research conducted in Italy and presented at the 15th World Conference on Lung Cancer in Sydney, Australia suggests that mesothelioma surgery – no matter what kind – may not offer a survival advantage over medical management for the healthiest of patients. Mesothelioma is a rare but aggressive malignancy that is highly resistant to standard cancer treatments. The two types of mesothelioma surgery considered to be options for people with resectable cancer are pleurectomy decortication (P/D) or extrapleural pneumonectomy (EPP). While EPP is more radical than P/D because it involves removing a lung, both carry a heavy risk of complications and, according to the Italian researchers, may not be of value for certain patients. The study reviewed data from 1,365…

Mesothelioma Surgery May Have Added Benefit
| |

Mesothelioma Surgery May Have Added Benefit

ByAlex Strauss

Cancer researchers at Wake Forest University have found another benefit to the cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) combination used to treat peritoneal mesothelioma and other abdominal cancers: the control of fluid buildup. Fluid accumulation in the abdomen because of peritoneal mesothelioma or another type of cancer is known as ascites. Left untreated, ascites can cause bloating, discomfort, disfiguration, and shortness of breath when it interferes with the movement of the diaphragm. While patients with peritoneal mesothelioma, an aggressive cancer of the peritoneal surface, can have this fluid drained off, it often reaccumulates. But the new Wake Forest research suggests that CRS/HIPEC may offer a more permanent solution. Fifteen percent of the cancer patients in the study had…

P/D for Mesothelioma: Are the Studies Accurate?
| |

P/D for Mesothelioma: Are the Studies Accurate?

ByAlex Strauss

A new analysis of pleurectomy/decortication suggests that the most radical form of the surgery produces the best results for mesothelioma patients, but also carries the greatest risk. Pleurectomy/decortication or P/D involves the removal of the pleural lining where malignant mesothelioma grows. Removing all or part of the lining frees up the lungs to expand again, relieving life-limited mesothelioma symptoms such as shortness of breath. But, as the Australian researchers found in their mesothelioma analysis, the varying degrees of P/D can make it difficult to accurately compare the method to the more extensive lung-removing surgery or even to get an accurate picture of P/D outcomes. Extended or ‘radical’ P/D involves removing the entire pleural lining, while partial P/D involves removing only part…

Mesothelioma Study Cites Risks & Benefits of Second Surgery
| |

Mesothelioma Study Cites Risks & Benefits of Second Surgery

ByAlex Strauss

Peritoneal mesothelioma patients who have cytoreductive surgery (CRS) and heated chemotherapy can sometimes benefit from a second surgery, but it may be harder the second time around. Researchers in France have recently published their findings in a study of patients with mesothelioma and other peritoneal cancers who experienced recurrence after  cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Peritoneal mesothelioma is an asbestos-related malignancy that spreads across the peritoneum, the membrane that lines the abdomen. For patients who are healthy enough to undergo it, cytoreductive surgery to remove as much of the cancer as possible, followed by a solution of heated chemotherapy drugs, has been shown to improve survival. But the French team wanted to examine the possible options for people…