Surgery – Memorial Sloan-Kettering Cancer Center
The two main surgeries available to pleural mesothelioma patients is a choice between extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). The EPP is the more invasive surgery and includes the removal of a lung. The P/D is sometimes called “lung sparring surgery” because both lungs are left in the patient.
The decision as to which of these two surgeries is better has been a hotly debated subject among mesothelioma specialists for decades. The EPP “camp” whose biggest advocate was the late Dr. Sugarbaker believed that EPP provided a significant survival advantage and patients lived longer. Most doctors in the pleurectomy/decortication camp believed that the survival difference between the two surgeries was minimal, but that P/D offered a better quality of life. Today, an extended pleurectomy/decortication is considered by most specialists to be the better option for more patients.
This study was published in 2008. It was designed to compare the two surgeries to see which one provided a longer survival to pleural mesothelioma patients.
The study ran from 1990 to 2006 and included 663 patients (538 men and 125 women). The median age was 63 years. Seven percent of the patients died during or immediately after the EPP. For pleurectomy/decortication, 4% died during the same period.
The doctors concluded that “patients who underwent pleurectomy/decortication had a better survival than those who underwent extrapleural pneumonectomy.” But, they also explained that the reasons were complicated and that the surgical decision should not be made based on a one size fits all approach.
Patients: This study involved 663 patients with malignant pleural mesothelioma. There were 538 men and 125 women. The majority of patients reported that they had been exposed to asbestos. They ranged in age from 26-93 years old; the median age was 63.
Treatment: These patients were treated with surgery, either pleurectomy/decortication or extrapleural pneumonectomy. These surgeries are different in that they remove different parts of the effected area of the body.
Toxicity: Grade 3-5 respiratory complication and arrhythmias were reported. The respiratory complications were the most common, reported in 6.4% of patients.
Results: The median overall survival of all patients was 14 months. Patients with different stages of disease/tumors had different survival times, which ranged from 38 months for those with stage I disease to 7 months with stage IV disease.
Support: One author of the study reported consulting fees from Glaxo-SmithKline and Astra Zeneca.
Correspondence: Dr. Raja M. Flores
See all conventional treatment results for mesothelioma.