The most aggressive surgery for mesothelioma could be more beneficial for patients with the disease. The more aggressive surgery is called an extrapleural pneumonectomy (EPP), which involves removing the lung. The other surgery, pleurectomy and decortication (P/D), spares the lung and only removes the lining of the lung and visible tumors. A study from Italy found that EPP helped mesothelioma patients with a high symptom burden live longer with a better quality of life compared to P/D. This information was reported in the Journal of Clinical Medicine on October 29 by the specialists at Tor Vergata University Policlinico in Rome. The researchers found that pneumonectomy had the longest lasting effects regarding symptom control, even with long lasting pain.
The study involved 55 pleural mesothelioma patients in Rome who either had a pneumonectomy or pleurectomy and decortication during a 14-year period. There were 29 patients who received an extrapleural pneumonectomy and 26 patients who received a pleurectomy and decortication. The patients who received the EPP were overall better off after the surgery. The quality of life of the patients were measured before the surgeries and then three, six, 12, and 24 months after surgery. The measurements involved a six-minute walk, body pain levels, physical functioning, vitality, and mental health. Physical, social, and pain related improvements lasted longer for the people in the extrapleural pneumonectomy group. Both procedures had at least a three-month improvement after surgery.
There were no differences between the two groups with chemotherapy and radiotherapy compliance. The groups saw a median overall survival of 20 months for extrapleural pneumonectomy and 13 months for pleurectomy and decortication. Two years after surgery, there were five of the 26 P/D patients still alive and four of the 29 EPP patients still alive. At the three-year mark, only four EPP patients were still alive. Doctors believe quality of life needs to be the main measurement for after surgery outcomes because the life expectancy for mesothelioma is low.
This study contradicts what most doctors have generally believed. They mostly believe that extrapleural pneumonectomy should be used sparingly because of its aggressiveness and debilitating side effects. Mesothelioma is usually caused by asbestos exposure. Microscopic fibers are inhaled and become lodged in lung and mesothelial tissue, causing cancer that grows throughout the thoracic cavity of the body. Pleurectomy and decortication surgery is a more precise surgery, but it is less life changing because it only removes the lining of the lung and any visible tumors in the body. Extrapleural pneumonectomy on the other hand removes the entire diseased lung along with parts of the diaphragm and pericardium. Despite these surgeries being effective, not many patients qualify for the surgeries because the cancer has spread too much and is usually too advanced. Other studies of the two surgeries have shown little difference in survival times (15 to 24 months). Most of the studies have concluded that there is a larger deterioration in quality of life with EPP.
The extrapleural pneumonectomy surgery was created around 20 years ago by Dr. David Sugarbaker. It was used quite often, but many surgeons now believe the risks of this type of surgery outweigh any benefits. Despite many doctors choosing to use pleurectomy and decortication instead of EPP, there are still many success stories of the surgery. One of the longest living pleural mesothelioma survivors is still alive because of it. He has been living for 20 years past his surgery date.
Source:
Riccardo Tajé et al., “Multifactorial Evaluation following Cytoreductive Surgery for Malignant Pleural Mesothelioma in Patients with High Symptom-Burden” Journal of Clinical Medicine (October 29, 2022). [Link]
