Retrospective Study Confirms Superiority of Less Aggressive Mesothelioma Surgery
Patients facing the grim outlook of a malignant pleural mesothelioma diagnosis are faced with a series of difficult treatment decision. Among the most challenging is whether to undergo an extremely aggressive form of surgery that sacrifices one of their lungs or a less aggressive-but-easier-to-tolerate procedure that leaves their lung and much of their thoracic tissue in place. The immediate reaction is often to “cut it all out” in hopes that the extreme removal of tissue will provide longer overall survival. But a recent study conducted by researchers in Japan has confirmed what many other experts have said in the past: When it comes to mesothelioma, more is not necessarily better.
Lung-Sparing Surgery Provides Better Results for Mesothelioma Patients
Publishing their findings in the esteemed Journal of Clinical Medicine, the team reported that after reviewing multiple studies encompassing data from more than 2,600 mesothelioma patients, they’ve concluded that the lung-sparing surgery known as pleurectomy with decortication is almost always superior to the more aggressive surgery known as extrapleural pneumonectomy. The researchers’ input is the latest to determine that the risks and complications associated with the more radical surgery make it the sub-optimal choice, especially because both procedures yield the same survival times.
Malignant pleural mesothelioma’s tumors form in the thoracic cavity, but not every patient is a candidate for surgery. For those whose tumors are accessible, the decision as to whether leave both lungs in place or remove one in an attempt to clear the body of cancer is momentous, as the more aggressive surgery can be extremely traumatic. Leaving both lungs in place carries much less risk.
Fewer Complications Make Less Aggressive Surgery the Better Choice
Speaking of the group’s findings, lead author Yoshinobu Ichiki said, “Our systematic review showed that lung-sparing surgery was significantly superior to lung-sacrificing surgery in both the surgical-related mortality and morbidity. Lung-sparing surgery was not inferior to EPP in terms of median survival time.” He explained that less than 10 percent of those who had the less aggressive surgery had major complications, while more than 20 percent of those who had the aggressive surgery did — and that more than 7 percent of those who sacrificed a lung died after their procedure compared to less than two percent of those who kept their lung.
“Although no prospective randomized controlled trial has been conducted, it may be time to change the standard surgical method for MPM from lung-sacrificing surgery to lung-sparing surgery,” they conclude.
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