Surgical Procedures for Mesothelioma: Understanding Extrapleural Pneumonectomy for Sarcoma

Surgical Procedures for Mesothelioma: Understanding Extrapleural Pneumonectomy for Sarcoma

ByHolly Zink

There are two common surgical procedures for mesothelioma: extrapleural pneumonectomy and pleurectomy decortication. Extrapleural pneumonectomy involves removing the lung affected by mesothelioma. Extrapleural pneumonectomy is a surgery. In it, part of the diaphragm and the linings of the lung and heart are also removed. This complex procedure is primarily performed in specialized centers. It is considered in cases of pleural-based sarcomas, among other conditions. Outcomes of Adult Patients: Key Findings A recent study described the characteristics and outcomes of adults who underwent extrapleural pneumonectomy for pleural-based sarcoma. Eight patients were included in the study. Primary outcomes were event-free survival and overall survival following the procedure. A study found that extrapleural pneumonectomy rarely cures adults with pleural-based sarcoma. Their median event-free…

New Surgery Gives Better Odds of Surviving Mesothelioma
|

New Surgery Gives Better Odds of Surviving Mesothelioma

ByHolly Zink

A surgery that removes the lining around the lung may give patients better odds of surviving mesothelioma. The surgery is known as pleurectomy decortication (PD). And it may give better odds than extrapleural pneumonectomy (EP). These two surgical procedures are the most used procedures for resectable malignant mesothelioma. A new article in the Journal of Clinical Medicine describes an analysis of mesothelioma survival after surgery. Surgical Treatment for Mesothelioma Malignant mesothelioma is a rare and aggressive cancer that rarely responds to a single cancer therapy. Malignant mesothelioma is caused by exposure to asbestos. Usually, that happens in the workplace. Pleurectomy decortication is a two-part surgical procedure to treat mesothelioma. The first stage removes the membrane surrounding the lung. The second…

Mesothelioma Surgeries Carry Similar Mortality Risk, Study Finds
| | |

Mesothelioma Surgeries Carry Similar Mortality Risk, Study Finds

ByAlex Strauss

The two major types of mesothelioma surgeries carry similar risk of death, according to a new study from cancer researchers in Japan.  One surgery involves removing the diseased pleural lining and one of the lungs. The other surgery removes many of the same tissues but leaves the lungs intact.  Surgeons around the world are divided as to which of these mesothelioma surgeries is best. Mesothelioma patients have more complications with lung-removing surgery. But some studies suggest it could lead to longer survival.  The 4-year Japanese study included more than 600 patients. It suggests that the likelihood of dying is similar with either of these mesothelioma surgeries.  Surgical Treatment of Pleural Mesothelioma Pleural mesothelioma is the most common type of asbestos…

Surgeons Disagree on Definition of Mesothelioma Surgery
| |

Surgeons Disagree on Definition of Mesothelioma Surgery

ByAlex Strauss

When surgery is indicated for mesothelioma, doctors typically turn to one of two procedures: extrapleural pneumonectomy or pleurectomy/decortication (P/D). Of the two, extrapleural pneumonectomy is the most extensive and risky, involving removal of a lung, the lining of the lung, and parts of the diaphragm. Though somewhat controversial, this mesothelioma surgery is well-defined in most centers. In contrast, a new study finds that surgeons vary widely in their definition of pleurectomy/decortication. To get a better understanding of what mesothelioma surgeons mean when referring to P/D, members of the International Association for the Study of Lung Cancer and the International Mesothelioma Interest Group conducted a web-based survey of 62 surgeons from 39 medical centers who had performed at least one mesothelioma…

Predicting Long-Term Mesothelioma Survival After Surgery
| | | | | | | |

Predicting Long-Term Mesothelioma Survival After Surgery

ByAlex Strauss

Most mesothelioma  patients and their families have heard the poor survival statistics associated with this aggressive cancer. But two new studies on two different types of mesothelioma suggest that long term survival is possible with surgery and can even be predictable. The first study was a multi-center analysis conducted in Italy between 2000 and 2010. Researchers retrospectively reviewed the cases of 468 malignant pleural mesothelioma patients who underwent extrapleural pneumonectomy – a radical surgery that involves removing the diseased pleural lining as well as the closest lung. Since most pleural mesothelioma patients die within a year of diagnosis, the research team classified those who lived three years or longer as “long term survivors.” A total of 107 mesothelioma patients (22.9%) fell into…

Study Defends Use of Radical Surgery for Mesothelioma
| | | | |

Study Defends Use of Radical Surgery for Mesothelioma

ByAlex Strauss

A new study says the controversial extrapleural pneumonectomy procedure for mesothelioma can be performed with “acceptable morbidity and mortality”, as long as certain guidelines are followed. Extrapleural pneumonectomy (EPP) is a large and complex procedure that involves removing a mesothelioma patient’s lung, lung lining, diaphragm and other tissues in an effort stop the spread of mesothelioma. Although some studies have indicated a mesothelioma survival benefit with EPP, the procedure has come under fire because of its high rate of death and complications. But the new EPP study suggests that it can be performed safely. The study evaluated the cases of 251 mesothelioma patients from three high-volume hospitals – University Hospital Zurich in Switzerland, Medical University Vienna in Austria, and Toronto…

EPP No, Chemotherapy Yes, Suggests New Mesothelioma Study
| |

EPP No, Chemotherapy Yes, Suggests New Mesothelioma Study

ByAlex Strauss

A pair of thoracic oncologists from Belgium say it’s time to go a step further in the wake of a controversial study on mesothelioma surgery and examine the impact of perioperative chemotherapy. Based on mesothelioma research from around the world, the 2011 Mesothelioma and Radical Surgery (MARS) randomized feasibility study concluded that extrapleural pneumonectomy (EPP) was too risky and should be abandoned as a surgical approach for mesothelioma. EPP involves removing not only the diseased pleura containing the mesothelioma tumor, but also the nearest lung, the diaphragm, and other internal membranes.  The MARS study recommended, instead, that operable mesothelioma be treated with lung-sparing pleurectomy/decortication (P/D) or extended pleurectomy/decortication. But surgery alone, regardless of which method is used, has been shown to produce…

New Radiotherapy Technique May be Safer for Mesothelioma
| |

New Radiotherapy Technique May be Safer for Mesothelioma

ByAlex Strauss

There’s more evidence that an advanced method for delivering radiotherapy may improve survival for mesothelioma patients after surgery. Extrapleural pneumonectomy (EPP) is a surgical procedure for malignant pleural mesothelioma that involves removing the mesothelioma tumor, as well as the pleural lining where the tumor is located, the nearest lung, all or part of the diaphragm, and other internal membranes. It is often followed by adjuvant radiotherapy to kill remaining tumor cells. Because the radiation target area in post-operative mesothelioma patients is irregular in shape and located close to critical internal organs, many patients receive a targeted type of radiotherapy called intensity modulated radiation therapy (IMRT). But postoperative IMRT also carries a high risk of a potentially fatal lung condition called…

Radiotherapy and EPP is a Winning Combo for Some Mesothelioma Patients
| |

Radiotherapy and EPP is a Winning Combo for Some Mesothelioma Patients

ByAlex Strauss

Another study has confirmed the value of radiotherapy as an adjuvant treatment for mesothelioma patients who undergo extrapleural pneumonectomy. A team of Italian researchers recently analyzed the records of 56 mesothelioma patients who had been treated with adjuvant radiotherapy after extrapleural pneumonectomy surgery (EPP) between 2005 and 2010. Caused by exposure to asbestos, malignant mesothelioma is a fast-growing cancer of the mesothelial lining around the lungs and other organs. Extrapleural pneumonectomy is a radical surgical procedure that involves removing not only the mesothelioma tumors, but also the lung closest to the tumor and a portion of the diaphragm. Although EPP is controversial due to its high rate of complications, a number of studies have shown it to increase survival, especially…

Open Biopsy Better for Diagnosing Mesothelioma Subtype
| |

Open Biopsy Better for Diagnosing Mesothelioma Subtype

ByAlex Strauss

Open surgical biopsy – called thoracotomy – appears to be the best way to get an accurate diagnosis of mesothelioma subtype. Mesothelioma is a fast-growing malignancy caused by asbestos exposure.  Epithelial mesothelioma is the most common subtype, followed by sarcomatoid and biphasic.  Determining which subtype a patient has is an important prognostic indicator and can help guide doctors in making treatment decisions. But mesothelioma itself is notoriously difficult to diagnose, and determining subtype can be equally tricky. To help determine the most accurate diagnostic method, a group of Australian scientists evaluated the records of 83 patients who underwent a surgical procedure called extrapleural pneumonectomy (EPP) for mesothelioma between 1994 and 2009. A panel of pathologists reviewed the specimens collected during EPP and…