Current surgical treatment of malignant pleural mesothelioma

Our plain-English summary of Current surgical treatment of malignant pleural mesothelioma, by K. Chihara (Respiratory Investigation, 2018).

The study

• Author: K. Chihara
• Journal: Respiratory Investigation
• Published: 2018;56(4):265-266
• Type of article: Editorial
• Read it: PubMed · Publisher

In plain English

This two-page editorial did not report new research. Its author, from a department of thoracic surgery in Shizuoka, Japan, discussed published reports on two operations for malignant pleural mesothelioma. Extra-pleural pneumonectomy (EPP) removes the lung together with the pleura, diaphragm and pericardium. Pleurectomy/decortication (P/D) removes the pleura but leaves the lung. The editorial does not discuss asbestos. The author noted that no randomized controlled studies had compared the two operations and that the best surgical approach remained controversial. Citing other studies, the author wrote that deaths after EPP had fallen to 2–7% in high-volume centers. A cited meta-analysis of 513 P/D and 632 EPP patients found lower mortality (2.9% vs 6.8%) and morbidity (28% vs 62%) with P/D. A cited US national cancer database report of 1036 P/D and 271 EPP patients found no differences in overall survival. The author wrote that P/D has been associated with more local recurrence and may be preferred for elderly patients. The author concluded that recent surgical developments may represent a paradigm shift.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Editorial (a narrative opinion piece discussing other published studies; no new data)
• Who was studied: No patients were studied by the author. The editorial discusses published reports on patients with malignant pleural mesothelioma treated with surgery.
• Exposure: Not an exposure study, and asbestos is not mentioned. The editorial compares two operations: extra-pleural pneumonectomy (EPP) and lung-sparing pleurectomy/decortication (P/D).
• Main results:
  • The author stated that the best operation is unsettled, with no convincing data favoring one over the other and no randomized controlled studies comparing EPP with P/D.
  • Citing other studies, the author wrote that mortality after EPP has been reduced to 2–7% in high-volume centers.
  • A cited systematic review and meta-analysis (not this article's own work) of 513 P/D patients and 632 EPP patients showed lower mortality (2.9% vs 6.8%) and morbidity (28% vs 62%) with P/D.
  • A cited US national cancer database report (not this article's own work) included 1036 patients (79%) who had P/D and 271 who had EPP. P/D patients were older, and no differences in overall survival were observed.
  • A cited study by Flores et al. reported better cumulative survival with P/D than EPP for early-stage disease, and better cumulative survival with EPP for late-stage disease.
  • The author wrote that P/D has been associated with a higher incidence of local recurrence than EPP because radiotherapy after P/D is limited by the risk of lung toxicity.
  • The author wrote that P/D may be preferred for the elderly and for people with poor cardio-pulmonary reserve, for whom EPP may not be feasible.
• The authors' conclusion: The author concluded that recent developments in surgical technique may represent a paradigm shift in the treatment of malignant pleural mesothelioma.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

Related studies

• Current surgical strategies for malignant pleural mesothelioma — T. Takuwa, S. Hasegawa (2016)
• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)
• Treatment of malignant pleural mesothelioma with chemotherapy preceding versus after surgical resection — V. Verma, C.A. Ahern, et al. (2019)
• Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma — T. Tanaka, S. Morishita, et al. (2017)
• Surgical treatment of peritoneal carcinomatosis: current treatment modalities — Y. Kulu, B. Müller-Stich, et al. (2014)
• Surgical Management of Malignant Pleural Mesothelioma: An Update of Clinical Evidence — C. Cao, Z. Akhunji, et al. (2015)

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