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Surgeons say research supports less-invasive procedure for pleural mesothelioma

Patients with early-stage pleural mesothelioma might be better off forgoing an extrapleural pneumonectomy, an aggressive surgery that involves removing the lung, chest lining and diaphragm, in favor of a less radical procedure, says a study to be published in the April issue of Journal of Thoracic Oncology.


Pleurectomy/decortication, or P/D, is safer and has a higher survival rate than extrapleural pneumonectomy, or EPP, said Loic Lang-Lazdunski, a surgeon at the Division of Cancer Studies, King’s College London, and the lead researcher on the study.


The findings are the latest in an ongoing debate among surgeons over the two procedures, which are performed on patients with early-stage pleural mesothelioma.


Once considered the standard of surgical care, EPP is typically part of a tri-modal treatment plan for mesothelioma that includes chemotherapy and post-operative radiation.


Studies have reported a five-year survival rate of about 40 percent among patients with more-favorable prognosis at the time of the treatment. But more than half of all patients cannot complete the EPP tri-modal therapy due to complications, and patients who relapse usually die within three months.


Pleurectomy/decortication involves removing the lung lining and any tumors inside the lining. It could also involve partial removals of the lung and the diaphragm. Previous research reports that, in conjunction with radiation and chemotherapy, P/D has a median survival rate of more than 20 months, with fewer complications.


In the current study, researchers analyzed the outcomes of the two regimens on 76 patients treated at a London hospital between January 2004 and June 2011.


Of the 22 patients who underwent EPP, 15 — 68 percent — experienced post-surgery complications. Only 27 percent of the 54 patients who underwent P/Ds suffered complications.


The survival rate for P/D patients was also significantly better than the EPP patients — 23 months for P/D versus 12.8 months for EPP. After two years, 49 percent of the P/D group was alive. Only 18.2 percent of the EPP group survived for two years after surgery. The five-year survival rate favored the P/D group, 30.1 percent versus 9 percent.


The researchers concluded, “Considering that EPP resulted in higher mortality and morbidity than P/D, that P/D resulted in significantly better survival in our experience as in others, we propose that P/D becomes the standard surgical procedure offered as part of multi-modality therapy in malignant pleural mesothelioma.”