Patients diagnosed with malignant pleural mesothelioma are most frequently offered a treatment approach that combines radiation therapy, chemotherapy and surgical removal of the tumors that have infiltrated the body. The specifics of that recommendation will be based on the specifics of their condition, the cell type of their cancer, and their physician’s beliefs regarding the type of surgery that offers the best outcomes. This is an issue that has long been discussed by mesothelioma surgeons, as there are two different approaches in common use: an aggressive operation that removes the entire lung and tissue around it, and a less aggressive approach that spares the lung. A new study has analyzed thousands of surgeries performed over the last twenty years and has concluded that the lung-sparing surgery is the better choice.
Research Reveals Higher 30-Day Mortality With Aggressive Mesothelioma Surgery
The research, which was published in the European Respiratory Journal, concluded that the lung-sparing pleurectomy and decortication (P/D) provides equivalent one-to-five year results as the more aggressive extrapleural pneumenctomy (EPP) surgery for mesothelioma patients but the P/D surgery provided better median overall survival. The EPP surgery had the highest 30-day mortality.
The study looked at 15 previously conducted studies, which encompassed 1,672 patient results following EPP surgery and 2,236 patient results following the P/D procedure. Those previous studies had been conducted between 1999 and 2018, in countries as diverse as the United States, South Africa, Japan, Switzerland, Germany, Italy and the United Kingdom.
Patients Are Better Able to Withstand P/D Surgery
Though mesothelioma surgeons have their preferences between the two surgical approaches, it is widely acknowledged that the EPP surgery is much harder on fragile patients, and less than one third of patients are considered candidates for the procedure. This is just one of the reasons that the P/D approach is more commonly performed.
With or without surgery, mesothelioma is acknowledged to be an incurable, terminal illness. Neither surgery can prevent tumors from returning. The goal of surgery in many cases is improved quality of life through reduction of symptoms and extended survival. Though there is little argument about whether the EPP surgery removes a greater quantity of malignant tissue — it does. But the study reveals that surgery also puts patients at higher risk for post-surgical complication and death, and significantly weakens patients without providing better outcomes.
Mesothelioma patients considering surgery should discuss the results of this study with their physicians. If you need any additional information about resources or research, contact the Patient Advocates at Mesothelioma.net at 1-800-692-8608.