Is it time to consider pleurectomy and decortication as the only surgical treatment for malignant pleural mesothelioma?

Our plain-English summary of Is it time to consider pleurectomy and decortication as the only surgical treatment for malignant pleural mesothelioma?, by M.J. Weyant (Journal of Thoracic Oncology, 2012).

The study

• Author: M.J. Weyant
• Journal: Journal of Thoracic Oncology
• Published: 2012;7(4):629-30
• Type of article: Editorial
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this editorial, the author discussed the choice between radical extrapleural pneumonectomy (EPP) and pleurectomy and decortication (P/D) as surgical treatments for malignant pleural mesothelioma (MPM). He wrote in response to a study by Lang-Lazdunski et al. He noted that EPP had been considered the gold standard operation, but that its operative mortality had been reported as high as 18% in some series. He summarized a series of 663 patients reported by Flores et al. That series suggested P/D might be superior in stage-I disease with R0 resection, and that EPP might benefit patients with more extensive disease. He also summarized the MARS trial, which randomized 50 patients and whose authors suggested EPP should be abandoned in trimodal therapy; that trial was criticized for its high surgical mortality and small sample size. The Lang-Lazdunski study involved a single surgeon at a single institution over 7 years. It reported surgical mortality of 4.5% for EPP and nil for P/D, and the authors stated that P/D patients had significantly improved survival in all parameters evaluated. The editorial argued that the study did not analyze why patients were steered toward P/D rather than EPP. It also argued that stage-for-stage survival conclusions were unfounded given the small subgroup sizes. The author concluded that the findings supported considering P/D in all MPM treatment trials, but that it was too early to abandon EPP altogether, as some patient subsets may benefit.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was an editorial by a thoracic surgeon, not an original study. It commented on a study by Lang-Lazdunski and colleagues that compared two operations for malignant pleural mesothelioma: extrapleural pneumonectomy (EPP) and pleurectomy and decortication (P/D). The author noted that the commented study had one surgeon at one institution over a 7-year period, and that it reported surgical mortality of 4.5% for EPP and none for P/D. The author also described two earlier studies: a 663-patient series by Flores and colleagues, and the MARS trial, which randomized 50 patients. The author criticized the commented study for not analyzing why patients were steered toward P/D rather than EPP. The author called its conclusion that P/D patients survived longer stage for stage unfounded, because the groups became very small once divided by stage. The author concluded that the study supported considering P/D in all treatment trials for this disease, but that it was too early to abandon EPP entirely. The editorial did 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: Editorial (commentary on another published study); no original data
• Who was studied: No study population of its own. The editorial discussed a single-surgeon, single-institution series of patients with malignant pleural mesothelioma treated by EPP or P/D (Lang-Lazdunski et al.), along with earlier studies.
• Exposure: No asbestos exposure was discussed. The subject was two operations for malignant pleural mesothelioma: extrapleural pneumonectomy (EPP) and pleurectomy and decortication (P/D).
• Main results:
  • The author reported that the commented study (Lang-Lazdunski et al.) had surgical mortality of 4.5% for EPP and none for the P/D group.
  • The author criticized the commented study for not analyzing the reasons patients were chosen for EPP versus P/D, such as physical status or patient preference.
  • The author judged the commented study's claim of longer survival with P/D stage for stage to be unfounded, because the sample sizes within each stage were very small.
  • The author noted that the MARS trial, which randomized 50 patients, had been criticized for an excessively high surgical mortality rate and a small sample size.
• The authors' conclusion: The author concluded that the commented study's results should lead to considering P/D in all trials of treatment for malignant pleural mesothelioma, but that it was too early to abandon EPP altogether, as some patient subsets may benefit.

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, Extrapleural Pneumonectomy (EPP).

Related studies

• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)
• Pleurectomy decortication in the treatment of the "trapped lung" in benign and malignant pleural effusions — S. Rathinam, D.A. Waller (2013)
• High dose irradiation after pleurectomy/decortication or biopsy for pleural mesothelioma treatment — E. Parisi, A. Romeo, et al. (2017)
• Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma — E. Taioli, A.S. Wolf, et al. (2015)
• Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma — S. Hasegawa (2014)
• Extrapleural Pneumonectomy Versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma — N. Zhou, D.C. Rice, et al. (2022)

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