Lack of evidence in malignant pleural mesothelioma surgery

Our plain-English summary of Lack of evidence in malignant pleural mesothelioma surgery, by O. Rena, C. Casadio (Interactive Cardiovascular and Thoracic Surgery, 2011).

The study

• Authors: O. Rena, C. Casadio
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2011;12(3):347-8
• Type of article: Comment, Editorial
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial comment discussed a published survey in which 802 thoracic surgeons from three international societies answered an online questionnaire about their opinions on surgery for malignant pleural mesothelioma (MPM). The authors noted that about half of the responders did not perform extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D), so their views came from the literature rather than personal experience. The other 352 surgeons (170 from Europe) reported performing these operations, but the authors could not obtain the crude data to judge how many operations each surgeon did. Because the disease is rare, they presumed most of these surgeons operated only occasionally. They concluded that the survey's educational value was limited and that its main value was descriptive. In their view, it showed that surgeons disagreed on the role of surgery, how extensive resection should be, and whether to combine surgery with other therapies. About 30% of responders, and about 50% in the USA, believed EPP alone could cure MPM. The authors attributed this belief to unclear use of the word 'cure'. They cited in-hospital morbidity and mortality of about 60% and 7% for EPP and about 25% and 4% for P/D. They stated that no randomised trials had shown either procedure to be more effective, and that ongoing and further randomised trials were needed.

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 article is an editorial comment, not an original study. The authors commented on a separately published survey in which 802 thoracic surgeons from three international societies answered an online questionnaire about surgery for malignant pleural mesothelioma. In that survey, about half of responders did not perform extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D), while 352 surgeons, 170 of them in Europe, said they performed both. The authors could not obtain the survey's raw data. They noted that the survey's own authors had said the many variables prevented statistical analysis. About 30% of responders, and about 50% of USA surgeons, answered that EPP alone can cure the disease, and the authors questioned this belief. They read the survey as showing that surgeons disagree on the role of surgery, its extent, and the need to add other therapies. They stated that randomised controlled studies have not shown either EPP or P/D to be more effective than the other. The authors concluded that surgeons lack demonstrated evidence to guide these operations and that more randomised trials are needed.

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 comment on a published survey of thoracic surgeons. No original data were collected by these authors.
• Who was studied: No population was studied by these authors. They commented on a survey (Treasure et al.) of 802 thoracic surgeons from three international societies who answered an online questionnaire on surgery for malignant pleural mesothelioma.
• Exposure: Not applicable. The article discusses surgical treatment of malignant pleural mesothelioma (extrapleural pneumonectomy and pleurectomy/decortication), not asbestos exposure.
• Main results:
  • In the survey commented on, about half of responding surgeons said they did not perform EPP or P/D surgery for mesothelioma.
  • In the survey, 352 surgeons worldwide, 170 of them from European countries, said they were experienced and performed both EPP and P/D.
  • The authors were unable to access the survey's crude data despite trying.
  • In the survey, about 30% of responders, and about 50% of thoracic surgeons in the USA, answered that EPP alone can cure malignant pleural mesothelioma.
  • The authors questioned the belief that EPP can cure the disease.
  • The authors' reading of the survey was that surgeons disagree on the impact of surgery, the extent of resection, and the need to combine surgery with other therapies.
  • The authors stated that randomised controlled studies have not shown either EPP or P/D to be more effective than the other.
• The authors' conclusion: The authors concluded that thoracic surgeons have no demonstrated evidence to guide them in proposing EPP, P/D or other surgery to patients, and that ongoing and further randomised trials are needed.
• Limitations the authors state:
  • The authors pointed out a limitation of the survey they commented on: its own authors said the high number of variables did not allow statistical analysis.
  • The authors said they could not assess the number of procedures per surgeon because the survey's crude data were not accessible.

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), Pleurectomy/Decortication (P/D).

Related studies

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• What is the best approach for surgery of malignant pleural mesothelioma? It is to put our efforts into obtaining trustworthy evidence for practice — T. Treasure (2016)
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• Current evidence base of FDG-PET/CT imaging in the clinical management of malignant pleural mesothelioma: emerging significance of image segmentation and global disease assessment — S. Basu, B. Saboury, et al. (2011)
• Current controversies regarding the role of asbestos exposure in the causation of malignant mesothelioma: the need for an evidence-based approach to develop medicolegal guidelines — A.M. Marchevsky, M.R. Wick (2003)

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