A new meta-analysis on surgical pleural mesothelioma treatment supports the recent move towards the less invasive type of surgery as better for patient survival.
Surgical treatment of mesothelioma aims to remove as much of the cancer as possible to try to prolong the life of mesothelioma patients.
Most common types of treatment for pleural mesothelioma
The two types of mesothelioma surgery used most often in managing pleural mesothelioma are:
Pleurectomy/decortication (P/D): Surgery to remove part of the covering of the lungs and lining of the chest and part of the outside surface of the lungs.
Extrapleural pneumonectomy (EPP): Surgery to remove one whole lung and part of the lining of the chest, the diaphragm, and the lining of the sac around the heart.
The debate over mesothelioma surgery
Medical mesothelioma experts have debated which surgery is better for mesothelioma care – lung-sparing P/D or lung-removing EPP. Those in favor of P/D highlight its faster patient recovery and fewer complications, while EPP supporters believe it is a better way to keep mesothelioma at bay for a longer period of time.
Statistically analyzing all research studies comparing the outcomes of both surgical types of mesothelioma treatment published between January 1990 and January 2014, revealed that patients who had EPP were more than twice as likely to die within 30 days of the strenuous operation. And after two years, there was no significant advantage for those who underwent and survived the riskier surgery.
The researchers, from Hofstra North Shore-LIJ School of Medicine and Mount Sinai Health System, analyzed 24 studies with a total of 1,512 patients treated with P/D, and 1,391 treated with EPP. Their results, published in The Annals of Thoracic Surgery, show that P/D results in fewer short-term patient deaths.
“The reanalysis of the large number or studies comparing P/D to EPP suggests that P/D is associated with a 2 ½-fold lower short-term mortality (perioperatively and within 30 days) than EPP,” write the authors. “Pleurectomy decortication should therefore be preferred when technically feasible.”
We’ve reported in Mesothelioma Circle that other individual factors may be important in determining which type of surgery is be the best course of malignant pleural mesothelioma treatment. These include the age of the patient, previous surgeries, stage of mesothelioma and chemotherapy. Malignant pleural mesothelioma represents around 75 percent of the approximately 3,000 cases of mesothelioma diagnosed annually in the U.S.