Japanese Study Shows P/D Surgery for Mesothelioma Offers Survival Advantage Over EPP

When a patient is diagnosed with malignant mesothelioma, they almost immediately sit down with their care team to create a care plan. With the treatments currently available, that plan is likely to include chemotherapy, and if possible it will include either extra pleural  pneumonectomy (EPP) surgery or pleurectomy with decortication (P/D) surgery, with the latter being far less invasive and physically taxing than the first. Now a a study conducted by researchers from Hiroshima University has revealed that no matter what type of mesothelioma a patient is diagnosed with, patients have longer survival following the lung-sparing P/D surgery than the more aggressive EPP surgery.

Comparing EPP and P/D Surgeries

The question of whether a pleural mesothelioma patient who is eligible for surgery should choose the EPP procedure or the P/D procedure has been argued over for years. There are many surgeons who argue in favor of EPP, which removes far more tissue vulnerable to recurrence of the cancerous cells, while others lobby for the P/D surgery, which is easier for the patient to recover from and which leaves the lung intact, thus making breathing easier.

With this controversy in mind, Japanese researchers set out to evaluate the difference in the outcomes that mesothelioma patients experience from these two surgeries. Analyzing the cases of 44 mesothelioma surgery patients, the scientists determine that the amount of time it took for tumors to begin growing back again was almost exactly the same between the two surgeries, but that there was a significant difference in time between how long the patients survived after the tumors returned. Patients who underwent P/D surgery survived far longer after their tumors returned than patients who had EPP surgery

Significant difference seen no matter what mesothelioma cell type

All of the patients who were observed in this study were treated using the first-line mesothelioma chemotherapy treatment of pemetrexed and cisplatin, only to have their tumors return. They then submitted to surgery, with 29 of them undergoing EPP and 15 of them undergoing P/D.  The researchers found that even among patients whose mesothelioma was identified as the epithelial cell type, which has the best survival odds, patients who chose EPP surgery did not survive as long as those who had P/D surgery.

Writing of his findings, study author Yuichiro Kai with the Research Institute for Radiation Biology and Medicine said, “Post-recurrence survival (PRS) among all patients was significantly longer in the P/D group even among patients with epithelial-type malignant pleural mesothelioma.”  Where patients who had EPP surgery had a median survival after recurrence of just six months, those who had the P/D surgery had a median survival after recurrence of 20 months, while 61 percent of P/D patients were alive a year-and-a-half after recurrence of cancer, only 8 percent of EPP patients were similarly still alive.

For patients diagnosed with malignant mesothelioma, this is invaluable information as they assess their future. For other helpful facts, contact the Patient Advocates at Mesothelioma.net at 1-800-692-8608.

Terri Heimann Oppenheimer

Terri Oppenheimer

Terri Heimann Oppenheimer is the head writer of our Mesothelioma.net news blog. She graduated from the College of William and Mary with a degree in English. Terri believes that knowledge is power and she is committed to sharing news about the impact of mesothelioma, the latest research and medical breakthroughs, and victims’ stories.

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