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Meta-Analysis Shows Better Short-Term Survival for Less-Aggressive Mesothelioma Surgery

P_D Surgery Improves Life for Pleural Mesothelioma Patients

A new meta-analysis performed by New York researchers continues the shift among surgeons towards pleurectomy/decortication (P/D) and away from extrapleural pneumonectomy (EPP) for patients with malignant pleural mesothelioma (MPM).

Among MPM patients who are strong enough to endure lengthy surgery for mesothelioma, both P/D and EPP procedures are used to remove mesothelioma tumors from the body in hopes of prolonging survival. There is a key difference between the procedures, though, in terms of aggressiveness. P/D involves removing the lung lining (the pleura, where MPM tumors originate) and other visibly malignant tissues. With EPP, the complete lung, along with diseased tissues, are removed.

Debate has been mounting among surgeons over whether the lung-sparing P/D or the lung-removing EPP is a more effective surgical treatment for mesothelioma. Those in favor of P/D point to faster patient recoveries and fewer surgical complications, while EPP proponents say that the surgery improves the chances that mesothelioma will not return post-surgery.

A number of studies over the year have lent support to both the P/D and EPP camps, which remain firmly divided. Doctors from the Hofstra North Shore-LIJ School of Medicine and Mount Sinai Health System sought to “answer the question as to which procedure…is more beneficial to malignant pleural mesothelioma patients’ outcome” by looking at studies that have compared the long term outcomes of P/D versus EPP from January 1990 to January 2014.

Their results, presented in an article published by The Annals of Thoracic Surgery, indicate that P/D results in fewer short-term patient deaths.

“The reanalysis of the large number or studies comparing P/C to EPP suggests that P/D is associated with a 2 ½-fold lower short-term mortality (perioperatively and within 30 days) than EPP,” write the authors. “Pleurectomy decortication should therefore be preferred when technically feasible.”

In spite of the meta-analysis results favoring P/D, it’s important to note that each surgery has its own advantages and disadvantages and the choice of which one is best for you depends on a number of factors, including the cancer stage, the surgeon’s experience and the surgery’s track record at the facility where it is to be performed.

Attendees of the 2012 International Mesothelioma Interest Group (IMIG) agreed on these points, as outlined in an article published in the Journal of Thoracic and Cardiovascular Surgery. They also agreed that patients with MPM should be initially evaluated in a multidisciplinary setting (one that includes medical oncology, radiation oncology and surgery) as part of multimodal MPM therapy.

Mesothelioma is an aggressive cancer with no known cure caused by exposure to asbestos. Malignant pleural mesothelioma represents around 75 percent of the roughly 3,000 cases of mesothelioma diagnosed in the United States each year. The disease can also affect the lining of the abdominal cavity, the lining of the heart, and in very rare cases, the testicular membrane.

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