How successful is lung-preserving radical surgery in the mesothelioma and radical surgery-trial environment? A case-controlled analysis

Our plain-English summary of How successful is lung-preserving radical surgery in the mesothelioma and radical surgery-trial environment? A case-controlled analysis, by Y. Shahin, J. Wellham, R. Jappie, et al (European Journal of Cardio-thoracic Surgery, 2011).

The study

• Authors: Y. Shahin, J. Wellham, R. Jappie, K. Pointon, A. Majewski, E. Black
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 2011;39(3):360-3
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To determine whether there is a survival benefit from open-lung-preserving surgery (radical decortication) for malignant mesothelioma, when compared with the non-radical approach in the mesothelioma and radical surgery (MARS)-trial era.

Methods: We compared outcomes between 13 patients with malignant mesothelioma, who underwent radical decortication (group RD, n = 13) with 13 case-matched patients, who had palliative surgery (group non-radical decortication (NRD), n = 13) over a period of 2 years from June 2006 onwards. Patients were matched for age, sex, histology, computed tomography (CT) stage, haematological indices, body mass index (BMI) and adjuvant chemotherapy. We compared perioperative and postoperative courses and long-term survival.

Results: Histology was 25% biphasic and 75% epithelioid in both the groups. There was no significant difference in the proportions receiving adjuvant chemotherapy (54%, p = 1.00), but more patients in the RD group received adjuvant radiotherapy (46% vs 15%, p = 0.20). Median survival was higher for all cell types in the RD group (16.9 months vs 6.8 months, p = 0.001).

Conclusion: Radical open-lung-sparing surgery may confer a survival advantage to patients with malignant mesothelioma, who are fit to undergo radical decortication followed by chemotherapy and radiotherapy. Trials of radical surgery versus no surgery should include lung-sparing operations.

Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

In plain English

This study from Nottingham City Hospital in the UK looked back at patients diagnosed with malignant mesothelioma between June 2006 and June 2008 who were unsuitable for, or declined to join, the MARS trial of extrapleural pneumonectomy. Of 57 such patients, 13 had radical decortication, an open operation that removes the pleura but keeps the lung. The other 44 had thoracoscopy with talc pleurodesis, and the authors matched 13 of them to the surgery group. Median survival, counted from diagnosis, was 16.9 months in the radical decortication group versus 6.8 months in the matched group (p = 0.001). For the epithelioid cell type it was 16.9 versus 5.3 months (p = 0.014). Each group had 54% receiving chemotherapy. Prophylactic radiotherapy was given to 6 of 13 surgical patients and 2 of 13 comparison patients (p = 0.20). The authors concluded the surgery may confer a survival advantage in patients fit enough to undergo radical decortication followed by chemotherapy and radiotherapy. They noted the study was retrospective and small, with possible selection bias. They also attributed the comparison group's low survival to more co-morbidity. The article did not report 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: Retrospective case-matched (case-controlled) comparison of two surgical treatment groups at one hospital
• Who was studied: 57 patients with malignant mesothelioma, diagnosed between June 2006 and June 2008 at Nottingham City Hospital, UK, who were unsuitable for or declined the MARS trial. 13 had radical decortication (group RD) and 44 had thoracoscopy and pleurodesis, of whom 13 were matched to the RD group (group NRD). Both groups had a male to female ratio of 12:1. Each group had 10 epithelioid and 3 biphasic cases.
• Exposure: The comparison is between treatments, not asbestos exposure. Radical decortication (open lung-preserving surgery) was compared with thoracoscopy and talc pleurodesis. Asbestos exposure and fiber types were not reported.
• Main results:
  • Survival was measured from the date of diagnosis to death or last follow-up.
  • For all cell types, median survival was 16.9 months in the radical decortication group and 6.8 months in the thoracoscopy and pleurodesis group (p = 0.001).
  • For the epithelioid cell type, median survival was 16.9 months in the radical decortication group and 5.3 months in the thoracoscopy and pleurodesis group (p = 0.014).
  • 54% of patients in each group received adjuvant chemotherapy (p = 1.00).
  • Prophylactic radiotherapy (20 Gy) was given to 6 (46%) of the radical decortication group and 2 (15%) of the comparison group. The difference was not statistically significant (p = 0.20).
  • In a multivariate analysis, adjuvant chemotherapy had a hazard ratio of 0.92 (95% CI 0.28 to 2.95). Adjuvant radiotherapy had a hazard ratio of 0.37 (95% CI 0.09 to 1.52).
  • In the radical decortication group, resection margins were negative in 7 (54%) patients and microscopically involved (R1) in 6 (46%) patients.
  • After radical decortication, median hospital stay was 13 days (interquartile range 10.5 to 19).
  • Complications after radical decortication included lower respiratory-tract infection in 4 (31%) patients and atrial fibrillation in 4 (31%) patients.
• The authors' conclusion: The authors concluded that radical open-lung-sparing surgery may confer a survival advantage in patients fit enough to undergo radical decortication followed by chemotherapy and radiotherapy. They also concluded that trials of surgery versus no surgery should include lung-sparing operations.
• Limitations the authors state:
  • The study was retrospective and small, and selection bias was possible.
  • The sample was too small to draw conclusions about the effect of adjuvant chemotherapy and radiotherapy on survival.
  • The groups differed before surgery in lung function (FEV1) and white cell count.
  • The authors attributed the comparison group's low survival to greater co-morbidity than in the radical decortication group.
  • Pathological staging could not be done for the comparison group.

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, Malignant Mesothelioma, Palliative Care, Histology, Chemotherapy, Biphasic Mesothelioma, Epithelioid, Median Survival.

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