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The Two Major Mesothelioma Surgeries Have Similar Death Rates

Published: May 7, 2021

Japanese researchers have found that the main two types of surgery for mesothelioma have similar risks of death. The surgeries either remove the diseased lung lining and one of the lungs or just the lining. Doctors do not agree what surgery is best for mesothelioma patients, but both surgeries have their benefits and drawbacks. When patients undergo lung removal surgery, there is a higher chance of complications, but there is also a higher chance of having a longer survival. The study occurred in Japan and had around 600 patients. It was able to find that the probability that someone dies from either surgery is very similar.

One of the surgeries is an extrapleural pneumonectomy. Doctors remove mesothelioma tumors and other tissue including the lung that is closest to the tumor. This surgery is more aggressive than the other. Since it is an aggressive surgery, it can take a long time to recover from it. The other type of surgery is a pleurectomy/decortication. The surgeons remove the same diseased tissue as an extrapleural pneumonectomy, but no lungs are removed. The recovery time is faster and there are fewer complications than the more radical surgery. Both surgeries require extensive surgical expertise and usually require patients to be in very good overall health.

The Japanese study consisted of 622 pleural mesothelioma patients found in the National Clinical Database. Surgeries occurred between the years 2014 and 2017. The surgical outcomes, risk factors, and complications were analyzed for each surgery type. There were 279 patients who received an extrapleural pneumonectomy and 343 patients who received a pleurectomy/decortication. Extrapleural pneumonectomies occurred most often in centers that did not have a lot of mesothelioma cases while pleurectomy/decortications were performed in centers that had more than ten cases in the four-year period. Forty-five percent of the extrapleural pneumonectomy group had complications while 36 percent of the pleurectomy/decortication patients had complications. The complications include heart failure and pneumonia for the pneumonectomy group and prolonged air leakage for the pleurectomy/decortication group. The number of patients that stayed in the hospital was similar to the patients who died within 30 days (3.2 percent vs 1 percent respectively).

The people who had the most complications after an extrapleural pneumonectomy were 65 and older. There were no risk factors for patients receiving a pleurectomy and decortication. With all the data, the researchers were able to determine that there was a low death risk associated with mesothelioma surgery, especially for patients who are receiving care in experienced care centers.

Masaki Hashimoto et al., “Japanese Current Status of Curative-Intent Surgery for Malignant Pleural Mesothelioma” The Annals of Thoracic Surgery (April 26, 2021). [Link]
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