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Does Follow-up Surgery for Recurring Malignant Mesothelioma Improve Survival?

A second mesothelioma surgery to treat a recurrence of malignant mesothelioma in the lining of the lung is not necessarily effective in helping patients live longer, Italian researchers say, based on a small study described in the January 2010 edition of The Annals of Thoracic Surgery, a medical journal.

The researchers, Dr. Leonardo Politi of the University of Florence, and Dr. Giuseppe Borzelleno of the University of Verona, examined the cases of 74 mesothelioma patients who underwent surgery over 20 years to remove a diseased lung as well the membrane tissue covering the lung and heart, and diaphragm muscle. The procedure is called an extrapleural pneumonectomy.

The researchers said that of 57 patients for whom there was follow-up medical information, 11 patients experienced a recurrence of mesothelioma a year-and-a-half to 12 years after the initial surgery. Of these, eight patients were in good enough health to undergo a second surgery in which additional diseased tissue was removed.

The length that the patients survived after their second surgery ranged from six months to 29 months with the median survival rate 14.5 months.

The researchers conclude that in the cases examined, the second surgery did not offer the expected curative benefits. They said the procedure should be considered a remedy that temporarily relieved a patient’s pain, but didn’t provide a cure. They argue that a second surgery should be considered an option for a select group of malignant mesothelioma patients who cannot undergo additional radiation therapy.

In an accompanying commentary, Dr. David Rice, director of the Mesothelioma Program at the University of Texas M.D. Anderson Cancer Center, writes that partial removal of malignant tumors to manage malignant pleural mesothelioma remains controversial surgery. Rice said that extrapleural pneumonectomies generally provided a more complete removal of tumors than simply removing the lining of the lung. Still he acknowledged that patients who underwent extrapleural pneumonectomies did not appear to survive longer than patients who underwent less radical surgeries.

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