What is the Best Approach to Surgery for Mesothelioma?

What is the best way to approach surgery for malignant pleural mesothelioma? Do more and better research.

That proclamation comes from a top researcher and cardiothoracic surgeon with University College London. Tom Treasure, MD, a professor in the Clinical Operational Research Unit, says current research is not sufficient to prove what type of mesothelioma surgery is best for most patients.

Two Types of Mesothelioma Surgery

There are two major approaches to surgery for mesothelioma and two schools of thought about their value.

Extrapleural pneumonectomy (EPP) is the more extensive of the two approaches. It involves removing not only the pleural lining where the mesothelioma tumor is located, but also the lung closest to the tumor, all or part of the diaphragm, the lining around the heart, and other at-risk tissues.

While pleurectomy/decortication (P/D) mesothelioma surgery also involves removal of many of the same tissues, it is a lung-sparing surgery, meaning both lungs are left in place.

Controversy Over Surgery for Mesothelioma

There is scientific evidence to support the value of both EPP and P/D and the world’s top mesothelioma surgeons remain divided over which approach is better.

Because EPP removes more at-risk tissue, some studies have found a survival benefit when this surgery is performed at an experienced center on well-selected mesothelioma patients. However, the risk of complications and death are higher with extrapleural pneumonectomy than with P/D.

By leaving both lungs in place, P/D has been shown to produce a better quality of life in mesothelioma patients, who tend to have fewer complications.

Lung-Sparing Surgery vs. Extrapleural Pneumonectomy

So which surgery is best for mesothelioma patients? In a new article in the Journal of Thoracic and Cardiovascular Surgery, Dr. Treasure says none of the current studies are sufficient to make that determination.

That is because current studies have essentially compared apples to oranges and, as a result, have reached vastly different conclusions about mesothelioma surgery.

“Because of the nature of the disease and the multiplicity of treatment protocols, defining the direction and magnitude of a survival difference cannot be determined from personal experience, follow-up studies or other methods lacking rigorous control data,” writes Dr. Treasure.

Instead, Dr. Treasure is calling for more randomized, independently run multicenter trials to help determine the best surgery for mesothelioma.

Source:

Treasure, T, “What is the best approach for surgery of malignant pleural mesothelioma? It is to put our efforts into obtaining trustworthy evidence for practice”, September 28, 2015, Journal of Thoracic and Cardiovascular Surgery, Epub ahead of print