Extrapleural Pneumonectomy Is Not Shown to Be Clinically Effective in the Treatment of Malignant Pleural Mesothelioma

Our plain-English summary of Extrapleural Pneumonectomy Is Not Shown to Be Clinically Effective in the Treatment of Malignant Pleural Mesothelioma, by G. Cardillo, T. Treasure (Annals of Surgery, 2017).

The study

• Authors: G. Cardillo, T. Treasure
• Journal: Annals of Surgery
• Published: 2017;265(4):e53
• Type of article: Letter
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is a letter to the editor, not a research study, and it reports no new data. The authors responded to a published series of 527 extrapleural pneumonectomy (EPP) operations for malignant pleural mesothelioma. They argued that the series' introduction quoted a median survival of 7 to 12 months, which they said may be misleading as a comparison. They cited earlier published work. In one data set of 945 patients considered for surgery, three groups survived an average of 17 to 18 months: those not operated on (387; 41%), those who had exploratory surgery without removal of the tumor (174; 18%), and those who had resection alone (177; 19%). The authors also noted that in the randomized MARS trial, patients eligible for EPP who were assigned not to have it had a median survival of 19.5 months. The authors concluded that the series' data cannot show that EPP is clinically effective, and that the accumulated evidence points away from EPP as clinically effective. The letter does not discuss 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: Letter to the editor commenting on a published surgical series. It reports no new data.
• Who was studied: No population was studied. The letter responds to a published series of 527 extrapleural pneumonectomy operations.
• Exposure: No asbestos exposure was studied. The letter concerns extrapleural pneumonectomy (EPP), a surgery for malignant pleural mesothelioma.
• Main results:
  • The authors argued that the series' introduction quoted a median survival of 7 to 12 months and that this may mislead readers as a comparison. Their reason was that the cited pemetrexed trial excluded possible surgical candidates.
  • The authors cited a previously published data set of 945 patients considered for surgery. Patients not operated on (N = 387; 41%), patients who had exploratory thoracotomy without resection (N = 174; 18%), and patients who had resection without other treatments (N = 177; 19%) all survived an average of 17 to 18 months.
  • The authors stated that, in the cited data set, there was no signal that surgical resection itself makes a difference.
  • The authors cited another published study. When EPP was compared with lung-sparing pleurectomy decortication (P/D), survival was poorer after EPP, even though P/D was used in patients in worse condition.
  • The authors cited the randomized MARS trial. In that trial, patients judged eligible for EPP who were randomly assigned not to have it had a median survival of 19.5 months.
• The authors' conclusion: The authors concluded that the data in the series cannot show that EPP is clinically effective. They also concluded that the accumulated evidence points away from EPP as clinically effective.

Topics

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

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

Related studies

• Extrapleural pneumonectomy for malignant pleural mesothelioma: outcomes of treatment and prognostic factors — T.D. Yan, M. Boyer, et al. (2009)
• Extrapleural pneumonectomy or supportive care: treatment of malignant pleural mesothelioma? — S. Sharif, I. Zahid, et al. (2011)
• Extrapleural pneumonectomy in the treatment of epithelioid malignant pleural mesothelioma: novel prognostic implications of combined N1 and N2 nodal involvement based on experience in 529 patients — D.J. Sugarbaker, W.G. Richards, et al. (2014)
• Extrapleural pneumonectomy in the treatment of malignant pleural mesothelioma — D.J. Sugarbaker, S.J. Mentzer, et al. (1992)
• Intensity-modulated radiotherapy after extrapleural pneumonectomy in the combined-modality treatment of malignant pleural mesothelioma — A. Chi, Z. Liao, et al. (2011)
• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)

Browse more research in Annals of Surgery, or return to medical research.