Extrapleural pneumonectomy for malignant pleural mesothelioma: is this an operation that should now be consigned to history?

Our plain-English summary of Extrapleural pneumonectomy for malignant pleural mesothelioma: is this an operation that should now be consigned to history?, by T. Treasure (Future Oncology, 2015).

The study

• Author: T. Treasure
• Journal: Future Oncology
• Published: 2015;11(24 Suppl):7-10
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In this paper, presented at the Second Mediterranean Conference in Thoracic Oncology, I argue that we can now set aside extrapleural pneumonectomy (EPP) as a treatment for malignant pleural mesothelioma and consign it to the history of surgery. There is sufficient evidence to conclude that EPP offers neither survival benefit nor net gain in quality of life. Individual surgeons may believe that for individual patients they have something to offer with EPP, but the onus is on them to fully inform the patient of their reasons for advising them contrary to the evidence that applies in general for this operation in this disease.

In plain English

This paper is an opinion piece, presented at the Second Mediterranean Conference in Thoracic Oncology. In it the author argued that extrapleural pneumonectomy (EPP), a major operation for malignant pleural mesothelioma, should be set aside as a treatment. The paper reported no new patient data. Instead it discussed other published work. The author cited a series of 447 patients who had EPP between 2001 and 2010 at Brigham and Womens' Hospital in Boston. In that series, the 169 patients selected to have EPP as their first treatment had a median survival of 15 months. The author pointed out that the series had no control group. The author also cited the MARS randomised trial, which found longer and better-quality survival in patients allocated not to have EPP. A survey of thoracic surgeons found that about 30% (45% of USA surgeons) believed EPP alone could cure mesothelioma. The author noted one published case of a patient alive without mesothelioma five years later but called it very atypical. The author concluded that EPP offers neither survival benefit nor net gain in quality of life.

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: Opinion/commentary paper presented at a conference, discussing published evidence; no original study data
• Who was studied: No study population of its own. The paper discusses patients with malignant pleural mesothelioma, including a cited series of 447 patients who had EPP at Brigham and Womens' Hospital, Boston, USA, between 2001 and 2010
• Exposure: Not an asbestos exposure study. The subject is a surgical treatment, extrapleural pneumonectomy (EPP), for malignant pleural mesothelioma
• Main results:
  • The author cited the Brigham and Womens' Hospital series: patients selected to have EPP as the initial treatment (169 of 447; 38%) had a median survival of 15 months. The author noted that the series had no control group.
  • The author cited the MARS randomised trial, which found that survival was significantly longer and of better quality in patients allocated not to have EPP.
  • The author cited the MAPS chemotherapy trial, in which overall survival was 18.8 months in the bevacizumab arm among patients considered unresectable.
  • The author cited a survey of members of three thoracic surgical societies: about 30% of thoracic surgeons, and 45% of USA surgeons, believed EPP alone could cure mesothelioma.
  • The author noted one published case report of a patient alive 5 years after EPP with no evidence of mesothelioma. The author considered the case very atypical.
  • The author cited a study in which less radical, lung-sparing surgery was associated with significantly longer survival, even though it was performed in patients with poorer prognosis.
• The authors' conclusion: The author concluded that there is sufficient evidence that EPP offers neither survival benefit nor net gain in quality of life. The author also wrote that surgeons who still advise it for individual patients should fully inform them of their reasons for going against the general evidence.

Topics

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

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma, Quality of Life.

Related studies

• Should we continue to offer extrapleural pneumonectomy to selected mesothelioma patients? A single center experience comparing surgical and non-surgical management — M. Baud, A. Bobbio, et al. (2014)
• Extrapleural pneumonectomy for early stage malignant pleural mesothelioma: a harmful procedure — O. Rena, C. Casadio (2012)
• Clinical impact of extrapleural pneumonectomy for malignant pleural mesothelioma — V. Ambrogi, A. Baldi, et al. (2012)
• Adjuvant radiotherapy after extrapleural pneumonectomy for mesothelioma. Prospective analysis of a multi-institutional series — S. Tonoli, P. Vitali, et al. (2011)
• Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma — S. Hasegawa (2014)
• Interim results of pleurectomy/decortication and intraoperative intrapleural hyperthermic cisplatin perfusion for patients with malignant pleural mesothelioma intolerable to extrapleural pneumonectomy — H. Ishibashi, M. Kobayashi, et al. (2015)

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