It has long been established that certain factors make patients poor candidates for aggressive mesothelioma surgery. However, a pair of thoracic surgeons from Leicester, England, have assembled a list of characteristics that they have found to be predictive of positive long term survival rates for those who undergo either one of two types of radical mesothelioma surgery.
Dr. Apostolos Nakas and Dr. David Waller of Glenfield Hospital are renowned for their surgical work in mesothelioma patients, and particularly for the surgeries known as extended pleurectomy with decortication (EPD) and extrapleural pneumonectomy (EPP).
In both surgeries the pleural lining around the lungs is removed, as well as all or part of the diaphragm and any other tissue that is determined to be diseased.
In the EPP procedure, the impacted lung is removed, while in the EPD procedure the lung is spared. The physicians set out to determine whether there were any indications that could be used to predict positive long-term outcomes,. They looked at the data for 252 pleural mesothelioma patients.
Of the group, 59 had been identified as having the biphasic type of the disease and 193 had the epithelioid type.
The results of their review showed that of the 252 patients, 140 had undergone EPD surgery and 112 had undergone EPP surgery. About half had received chemotherapy prior to surgery or post-operatively. The team determined that neither type of surgery showed a survival difference in the patients included in their study, but that other factors did play a part.
The most positive predictor for survival of at least two years was whether the patient was under the age of sixty. Other positive predictors included having the epithelioid form of the disease, receiving chemotherapy, and having no indication that the cancer had spread to the lymph nodes.
Overall, the median survival rate for the 252 patients was 18.2 months, with almost one third having lived a minimum of 24 months, the period of time that the researchers identified as being “long-term.”
According to Drs. Nakas and Waller, “These results support a policy of accurate preoperative tissue diagnosis, nodal staging, and induction chemotherapy prior to radical surgery for malignant pleural mesothelioma, which can result in long term survival. Trials investigating the role of surgery should be focused on confirming and refining these selection criteria.”