From the blog

Second Mesothelioma Surgeries Can Help Extend Lives and Improve Quality of Life of Patients

Published: March 26, 2021

Surgery can be hard on the body, but it can help some mesothelioma patients if done a second time. People could still have a good quality of life and even an extended survival if they undergo the aggressive surgery. This surgery is not common and would not be recommended for everyone, but people who fit the criteria could benefit. Some cancer centers don’t believe that even a first surgery for mesothelioma is good, so there is not always agreement among physicians on how mesothelioma should be treated. The patients in the study either had a pleurectomy and decortication or an extrapleural pneumonectomy as a primary surgery.

The researchers found that there are three important things that lead to a successful second surgery: a longer period of time where the cancer does not come back,  the patient having epithelial mesothelioma instead of sarcomatoid or biphasic cell types,  and the patient having a localized recurrence of mesothelioma compared to a diffused recurrence. If recurrence is diffuse, the quality life of the patient after the surgery would create pain without having a survival benefit, so it would not be advisable to undergo a second surgery. Patients who are in a healthier and better condition will also have a better chance of having a successful surgery.

The study is being done at the University Hospital in Cairo, which is a leader in mesothelioma research in the middle east. It is near many manufacturing plants that used asbestos. The hospital has not done many second mesothelioma surgeries though. The United States has multiple cancer centers that do aggressive surgeries for mesothelioma, but only a very small amount do a second surgery after mesothelioma has recurred. Surgery is already uncommon since less than one third of patients are eligible to receive it.

This study is similar to studies done in the past. There were three smaller studies with a total of 40 patients getting a second surgery to try to cure their mesothelioma. The first group contained sixteen patients who had a median survival of 20.4 months for epithelioid mesothelioma patients and 7.4 months for biphasic mesothelioma patients who received a second surgery. Within the epithelioid group, the patients whose mesothelioma did not recur for 24 months or longer had a median survival of 35.8 months versus the patients whose mesothelioma recurred within 12 months having an 8.9-month survival.

The second group of 16 patients who underwent surgery had two patients that died before leaving the hospital. The 14 patients that lived after surgery had a 16-month survival. Patients who only received chemotherapy and did not have a second surgery had a nine-month survival. Patients who did not receive therapy after the cancer recurred on the other hand had a two-month survival. The third group had eight patients who had a median survival of 14.5 months after receiving a second surgery. The evidence is not strong enough yet to conclude that a second surgery is beneficial to a large number of patients, but more research could be done to get more data.

Hany Hasan Elsayed et al., “Recurrence of mesothelioma after a macroscopic complete resection procedure: is a second radical surgery justified?” Interactive Cardiovascular and Thoracic Surgery (January 26, 2021). [Link]
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