Meta Analysis Finds Lung Sparing Surgery is Best Option for Mesothelioma Patients
By Kathy Cooke. 8th November 2018
There is now more evidence to support the growing number of experts who favour lung-sparing P/D (Pleurectomy/Decortication) surgery over the radical and more aggressive extrapleural pneumonectomy (EPP) for the treatment of malignant pleural mesothelioma.
Less than 25% of those diagnosed with malignant pleural mesothelioma are considered candidates for the two major surgical options. Unfortunately, the disease is often not diagnosed until its latter stages when surgery is no longer a viable option.
There has been an ongoing debate within the surgical community over which procedure carries the most benefit with the least risk.
A US surgeon at a medical centre in Houston, Texas was a pioneer of the EPP procedure.
The procedure involves removing the diseased mesothelium (pleural lining) containing the mesothelioma tumours as well as the nearest lung, most of the diaphragm, the pericardium, and other at-risk tissues.
The surgeon and his team were able to show a mesothelioma survival benefit with EPP. However the results, based on years of experience, were not typical.
Mesothelioma Surgery Options: Pleurectomy/Decortication V Extrapleural Pneumonectomy
P/D surgery, which is more precise and detailed but less life changing, removes the lining around the lung and all visible tumour cells throughout the chest cavity. The surgery often lasts at least 9 hours.
The writers of an updated meta-analysis of survival after P/D versus EPP, which goes back as far as 1990, the average survival rate was significantly increased in the P/D group. The risk of death within 30 days of the mesothelioma surgery was much lower among patients who had the Pleurectomy/Decortication surgery, as were the side effects of surgery.
Surgeon Dimitrios Magouliotis from The University Hospital of Larissa in Greece said:
“ The incidence of postoperative atrial fibrillation, haemorrhage, empyema, bronchopleural fistula and air leak was significantly increased in the EPP group. ”
The Meta Analysis Includes Past Mesothelioma Studies
A meta-analysis is essentially a study of studies.
The meta-analysis conducted by Mr Magouliotis and his team took data from 15 previous studies between 1990 and 2018 and included a total of 1,672 patients with malignant pleural mesothelioma.
Despite an increase of side effects among the EPP patients, the risk of death within 90 days, and up to 3 years did not
differ significantly between those who had the more extensive surgery and those whose lungs were left in place.
Researchers determined that given all the evidence from multiple different centers, P/D is the clear winner between the two types of mesothelioma surgery.
Dr. Magouliotis concluded that:
“ The present meta-analysis indicates that P/D is associated with enhanced outcomes regarding 30-day mortality, median overall survival, and complications. The P/D approach should, therefore, be preferred when technically feasible.. ”
However, the team also acknowledged that the choice of surgery for pleural mesothelioma is a decision that must take into account the experience of the surgeon as well as the patient’s disease status.
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1. Springer Link. 29 October 2018. Updated meta-analysis of survival after extrapleural pneumonectomy versus pleurectomy/decortication in mesothelioma
National Center for Biotechnology Information. June 2017. Extrapleural pneumonectomy (EPP) vs. pleurectomy decortication (P/D)
Further Reading . . .
Kathy Cooke MA. BSc
Cancer consultant and advisor
Kathy has worked in the cancer field for over 30 years. She was course leader for the MSc in Radiotherapy and Oncology at University of Hertfordshire. Then pre-treatment radiotherapy manager at the Cromwell Hospital in London and Partnership Quality Lead for Macmillan Cancer Support.. Read more >