Mesothelioma is an insidious disease which sadly has no cure. However, for some mesothelioma sufferers, surgery could help relieve symptoms and give more time.
Mesothelioma is often not diagnosed until it is at an advanced stage. By this point, many patients are not well enough to endure surgery. This is particularly the case with peritoneal mesothelioma, where the only surgical option is cytoreductive surgery, a complex operation lasting around 12 hours. For pleural mesothelioma, there are two surgical options; pleurectomy or extrapleural pneumonectomy (EPP).
A pleurectomy involves removing the lining of the lung, the pleura. The space around the lung is then treated to stop fluid build up. This is called decortication. An EPP is a radical surgery which involves removing the pleura, along with the affected lung, diaphragm and the lining covering the heart, the pericardium. EPP is major surgery and so many mesothelioma patients would not be able to tolerate such an invasive procedure.
As with any surgery, there are risks and benefits to consider and new research may be able to assist mesothelioma patients in making a decision.
Researchers in Canada and Japan have developed a system to predict how mesothelioma patients will deal with radical surgery, based on a blood test. A simple test can calculate the platelet to lymphocyte ratio (PLR) of a patient. This shows how effectively the immune system is working. When the body is under threat, the immune system should respond by producing more lymphocytes, or white blood cells.
Researchers reviewed 65 cases of pleural mesothelioma where the patients underwent EPP. It was found that those with a high PLR score had the shortest post-surgery survival, with an average between 19 months and 32 months. Those patients with a low PLR score had an average post-surgery survival of just over 45 months.
It is hoped that this research can be taken further and the simple blood test can be used to help those contemplating mesothelioma surgery.
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Source: Tagawa, T, et al, “Clinical role of new prognostic score using platelet-to-lymphocyte ratio in patients with malignant pleural mesothelioma undergoing extrapleural pneumonectomy.” November 2015.