Divided by an ocean of water but united in an ocean of uncertainty: A transatlantic review of mesothelioma surgery guidelines

Our plain-English summary of Divided by an ocean of water but united in an ocean of uncertainty: A transatlantic review of mesothelioma surgery guidelines, by D.A. Waller, I. Opitz, R. Bueno, et al (The Journal of Thoracic and Cardiovascular Surgery, 2021).

The study

• Authors: D.A. Waller, I. Opitz, R. Bueno, P. Van Schil, G. Cardillo, D. Harpole, P.S. Adusumilli, M. De Perrot
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2021;161(6):1922-1925
• Type of article: Editorial
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article is an editorial, not an original study. Eight thoracic surgeons from Europe and North America compared what two sets of guidelines say about surgery for malignant pleural mesothelioma: the recently published European guidelines and the American Society of Clinical Oncology (ASCO) guidelines. The authors reported broad agreement on several points. These included the surgeon's role in diagnosis through pleural biopsies and use of the eighth edition of the TNM staging system. The clearest differences concerned radical surgery. The North American guidance was more supportive of it, while the Europeans recommended it within clinical trials or registries. The two sides also differed on the timing of chemotherapy, on what counts as complete removal of the tumor, and on radiotherapy. The authors wrote that, for radical surgery, the strength of the recommendations is typically not matched by the strength of the evidence. They concluded that the differences reflect areas where good evidence is lacking. While awaiting results of the MARS2 trial, they considered surgery within multimodality treatment justified for patients with epithelioid tumors and no clinical evidence of nodal disease. The editorial does not study asbestos exposure.

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 comparing two clinical practice guidelines (not original research)
• Who was studied: Two guideline documents on malignant pleural mesothelioma: the recently published European guidelines (ERS/ESTS/EACTS/ESTRO) and the ASCO guidelines published about 2 years earlier; no patients were studied
• Main results:
  • Both guidelines agreed that surgeons have a role in diagnosis by obtaining sufficient large and deep pleural biopsies
  • Both guidelines approved the eighth edition of the TNM staging system
  • The North American guideline tended toward more complete staging for all patients, with routine PET-CT; the European approach was more selective about PET and MRI
  • The North American guideline was far more supportive of radical (cytoreductive) surgery; the European guideline recommended radical surgery within clinical trials or registries
  • The European approach tended to favor chemotherapy before surgery in all potentially resectable cases; the North American approach favored primary surgery in stage I and II followed by chemotherapy
  • The definition of macroscopic complete resection differed: the North American definition accepts a 1 cm area of residual disease, while in Europe it means all visible tumor
  • ASCO strongly recommended adjuvant high-dose hemithoracic radiotherapy; the European guideline was more guarded and recommended more research only
  • For radical surgery, the authors stated that the strength of the recommendations is typically not borne out by the strength of the evidence
• The authors' conclusion: The authors concluded that the guidelines agree on much, and that where they differ, good evidence is currently lacking. While awaiting MARS2 results, they considered offering surgery within multimodality treatment justified for patients with epithelioid tumors and no clinical evidence of nodal disease.

Topics

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

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

Related studies

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• The role of imaging in malignant pleural mesothelioma: an update after the 2018 BTS guidelines — S. Sinha, A.J. Swift, et al. (2020)
• Development of a guideline on reading CT images of malignant pleural mesothelioma and selection of the reference CT films — H. Zhou, T. Tamura, et al. (2012)
• Evaluation of the efficacy of the guideline on reading CT images of malignant pleural mesothelioma with reference CT films for improving the proficiency of radiologists — H. Zhou, T. Tamura, et al. (2013)
• British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma — I. Woolhouse, L. Bishop, et al. (2018)
• The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence — P. Bertoglio, D.A. Waller (2016)

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