Study Debates Different Approaches to Treating Mesothelioma
A recent study by doctors at the Icahn School of Medicine at Mount Sinai Hospital in New York City promotes the use of the surgical procedure known as pleurectomy and decortication (P/D) over the more aggressive extrapleural pneumonectomy (EPP) in the treatment of patients with malignant pleural mesothelioma.
According to the study, which was recently published in the Journal of Surgical Oncology, patients who underwent EPP were much more likely to die or suffer very serious complications within 30 days of the procedure, which is quite radical and involves the removal of the diseased lung as well as the pleural lining around it, lymph nodes, the pericardium (lining of the heart), and parts of the diaphragm.
Even when successful, the surgery demands months and months of recovery and rehabilitation.
While the P/D is more detailed than the EPP, it leaves the lung intact while removing the pleura and any other diseased tissue detected in the chest cavity.
Recovery is far shorter, and this quicker recovery allows for doctors to start adjuvant therapies to kill remaining cancer cells much sooner after surgery, once again improving life expectancy.
“Surgeons used to think [EPP] was the best operation, but we’re now finding that those microscopic bits of tumor left behind are not so problematic,” said study co-author, Dr. Andrea Wolf, a thoracic surgeon at Mt. Sinai. “A lot of data out there suggests that patients having the pleurectomy do better in the long run.”
The study largely focused on the 30-day mortality rate of the two vastly-different surgeries as well as the post-operative complications associated with each.
It considered 39 previous studies as well as data from the New York Statewide Planning and Research Cooperative System database for the years 1995 to 2012.
A compilation of all the data revealed the following:
- 30-day mortality rate: EPP 5 percent; P/D 2 percent
- Rate of post-operative complications: EPP 46 percent; P/D 24 percent
- Post-operative arrhythmias detected: EPP 20 percent; P/D 5 percent
Neither of these surgeries, of course, cures mesothelioma. There is no cure for any kind of mesothelioma, pleural or otherwise. Some people opt for the surgeries, however, because they are shown to extend the patient’s life expectancy, though only by approximately 6 months.
As a matter of fact, another recent study published in Clinical Lung Cancer shows a 14.7-month life expectancy without surgery and 20.9 months with surgery.
In addition, 15 percent of those who opted for surgery reached that all-important five-year survival milestone while only 1 percent of those who didn’t have surgery made it to the five-year point.
Quite obviously, there’s still a long way to go in the treatment of mesothelioma. While some targeted immunotherapy drugs are being tested for treatment of this aggressive cancer, none have yet been successful enough to be recommended as a first- or even second-line treatment.