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The Mesothelioma Surgery Debate: Is it Over?

fx1_lrgOne of the country’s top experts in mesothelioma treatment says, when it comes to surgery, the evidence points to better survival with pleurectomy and decortication (PD) than with the more radical extrapleural pneumonectomy (EPP).

The controversy over which type of mesothelioma surgery is best has gone on for years, with strong disagreement between respected surgeons.

But Raja Flores, MD, a thoracic surgeon and researcher with Mount Sinai Health System in New York, says, after years of comparative studies, including a new one from Turkey, the data points to PD as the better approach for optimizing mesothelioma survival.

Two Types of Mesothelioma Surgery

PD is the more conservative of the two mesothelioma surgical approaches. It involves removing the diseased pleural lining around the lungs, all or part of the diaphragm, the membrane that surrounds the heart, and other at-risk tissues.

EPP is similar but goes a step further and removes the lung closest to the mesothelioma tumor, as well.

While some studies have shown a survival advantage with EPP, others have found that the higher risk of death and complications from this type of mesothelioma surgery, outweigh the potential benefits.

Newest Evidence for Mesothelioma Treatment

Dr. Flores made his comments about PD being the better mesothelioma treatment approach in a recent issue of the Journal of Thoracic and Cardiovascular Surgery.

In the article, he pointed to another study, published in the same journal, of 72 Turkish mesothelioma patients. who underwent either EPP or PD.

After accounting for all variables, the Turkish researchers concluded that there was no significant survival difference between the two types of mesothelioma surgery.

Weighing the Benefits and Risks of Mesothelioma Surgery

Some top centers still perform EPP surgery, and prefer it because of its ability to remove more mesothelioma cells than PD can. But Dr. Flores says, on balance with the risks of lung removing surgery, the fact that PD may not remove as much of the disease is an acceptable trade-off.

“The take-home message is analogous to the concept of the law of diminishing returns, remove as much tumor as possible but without sacrificing the lung,” writes Dr. Flores.

Although new drugs may one day negate the need for mesothelioma surgery, Dr. Flores concludes his article by saying that, as long as surgery is still an option, “we have our answer – for now.”


Flores, R, “The mesothelioma surgery shift”, October 22, 2015, J Thoracic Cardiosvasc Surg, Epub ahead of print

Batirel, H.F., et al,. Adoption of pleurectomy and decortication for malignant mesothelioma leads to similar survival as extrapleural pneumonectomy. J Thorac Cardiovasc Surg. October 9, 2015, [Epub ahead of print]

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