National Cancer Database Report on Pneumonectomy Versus Lung-Sparing Surgery for Malignant Pleural Mesothelioma

Our plain-English summary of National Cancer Database Report on Pneumonectomy Versus Lung-Sparing Surgery for Malignant Pleural Mesothelioma, by Z.M. Abdelsattar, S.A. Saddoughi, S.H. Blackmon (Journal of Thoracic Oncology, 2018).

The study

• Authors: Z.M. Abdelsattar, S.A. Saddoughi, S.H. Blackmon
• Journal: Journal of Thoracic Oncology
• Published: 2018;13(4):e64-e65
• Type of article: Letter, Comment
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is a letter to the editor, not an original study. Three thoracic surgeons at the Mayo Clinic in Rochester, Minnesota, commented on an earlier article by Verma et al. That article used the National Cancer Database (NCDB) to compare pneumonectomy with pleurectomy/decortication for malignant pleural mesothelioma. The letter noted that Verma et al. reported pleurectomy/decortication as the most commonly performed procedure in the United States and found no measurable differences in survival between the two operations. The authors argued that the NCDB surgical codes are nonspecific. Using the coding manual, they pointed out that the codes Verma et al. assigned to the two operations describe things such as local tumor excision, photodynamic therapy, cryosurgery, debulking or radical surgery, and that some of the codes are not defined. They argued that this misclassification tends to push results toward showing no difference and might contribute to the similar readmission and mortality findings. They suggested checking the codes against institutional NCDB data. The authors concluded that readers should interpret the results with caution. 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 another group's published database study (Verma et al., J Thorac Oncol 2017); no new data
• Who was studied: No study population of its own; the letter discusses Verma et al.'s analysis of National Cancer Database data on surgery for malignant pleural mesothelioma in the United States
• Exposure: No asbestos exposure is discussed. The 'exposure' at issue is the type of surgery (pneumonectomy versus pleurectomy/decortication) as defined from NCDB surgical codes
• Main results:
  • The letter noted that Verma et al. (not this letter) reported that pleurectomy/decortication was the most commonly performed procedure in the United States and found no measurable survival differences compared with pneumonectomy
  • The authors argued that the NCDB surgical codes for mesothelioma are nonspecific and that it is virtually impossible to tell a pleurectomy from a pneumonectomy using them
  • According to the coding manual cited by the authors, the codes Verma et al. used (20 to 23, 30, 33, 40, 45 to 48 and 50 for pleurectomy/decortication; 55 to 56, 60, 66 and 70 for pneumonectomy) cover procedures such as local tumor excision, photodynamic therapy, electrocautery, cryosurgery, debulking and radical surgery. Codes 45 to 48 are not defined, and the other codes used for pneumonectomy are not specified in the manual
  • The authors described this as nondifferential misclassification that tends to bias results toward the null and might contribute to the similar readmission and mortality findings
  • The authors suggested validating the code definitions by comparing them with institutional NCDB data
• The authors' conclusion: The authors concluded that, without such validation, readers should be cautious in interpreting Verma et al.'s results, because the coded exposure may not accurately represent pneumonectomy versus pleurectomy/decortication

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: Pneumonectomy, Pleural Mesothelioma.

Related studies

• National Cancer Database Report on Pneumonectomy Versus Lung-Sparing Surgery for Malignant Pleural Mesothelioma — V. Verma, C.A. Ahern, et al. (2017)
• Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study — T. Treasure, L. Lang-Lazdunski, et al. (2011)
• Predictors and Outcomes of Surgery in Peritoneal Mesothelioma: an Analysis of 2000 Patients from the National Cancer Database — L. Bijelic, K. Darcy, et al. (2020)
• Which is the Role of Pneumonectomy in the Era of Parenchymal-Sparing Procedures? Early/Long-Term Survival and Functional Results of a Single-Center Experience — A. Janet-Vendroux, M. Loi, et al. (2015)
• A systematic review of lung-sparing extirpative surgery for pleural mesothelioma — E. Teh, F. Fiorentino, et al. (2011)
• Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma — E. Taioli, A.S. Wolf, et al. (2015)

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