There has been much debate on the best approach for surgery as a treatment for pleural mesothelioma. Now researchers in Japan have given their view on the controversial subject.
A patient’s eligibility for any kind of surgery depends on their level of health, location of the cancer and progression of the cancer. Not all patients who are eligible for surgery will have it, the decision is very much the patient’s and they have to weigh up the risks and rewards to decide if they want to go down the surgical route.
Pleural mesothelioma surgery can be radical or conservative.
Extrapleural pneumonectomy (EPP)
The radical surgery option for mesothelioma is an EPP. This is where the mesothelioma tumours, other tissues and the most affected lung are removed. This is a radical surgery and does carry high risks for complications post-surgery and sadly in some cases, death. However, it is argued that because so much is taken away, there is a better chance of survival.
For pleural mesothelioma, a lung-sparing surgery would be a pleurectomy with decortication (PD). Although this is also major surgery, it is seen as the conservative option as the lungs are not taken away. The lining of the lungs is removed along with any affected tissue. This method has lower risks for complications than an EPP.
Researchers looked at 15 studies about mesothelioma surgery and were able to view over 2,600 pleural mesothelioma patients. Of these, around 1,400 patients had EPP surgery and the remainder had lung-sparing surgery.
The study found that less than 10% of patients who had lung-sparing surgery suffered major complications, compared to more than 20% of EPP patients.
Overall, those who had lung-sparing surgery had better results than those who had an EPP. Lead researcher, Yoshinobu Ichiki said; “Our systematic review showed that lung-sparing surgery was significantly superior to lung-sacrificing surgery in both the surgical-related mortality and morbidity. Lung-sparing surgery was not inferior to EPP in terms of median survival time.”
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Ichiki, Y, et al, “Should Lung-Sparing Surgery Be the Standard Procedure for Malignant Pleural Mesothelioma?”, July 8, 2020, Journal of Clinical Medicine, https://www.mdpi.com/2077-0383/9/7/2153