Radical surgery for mesothelioma: how can we obtain evidence?

Our plain-English summary of Radical surgery for mesothelioma: how can we obtain evidence?, by T. Treasure, S. Swift, C. Tan (World Journal of Surgery, 2003).

The study

• Authors: T. Treasure, S. Swift, C. Tan
• Journal: World Journal of Surgery
• Published: 2003;27(8):891-4
• Type of article: Editorial
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos exposure in industry and construction sites in the 1960s and 1970s has left a legacy of mesothelioma, a diffuse pleural cancer, with a lag time of 40 to 50 years and due to peak around 2015 to 2020. Some surgeons believe that by radical surgery they can prolong life and relieve symptoms, but the evidence comes from very carefully selected series. How do surgeons respond to demand for evidence of benefit? In this article we explore how evidence for major surgical operations has been gained and how mesothelioma fits into this history.

In plain English

This article was an editorial, not a research study, and it reported no new data. The authors discussed whether radical surgery, mainly the operation called extrapleural pneumonectomy, helps patients with diffuse malignant pleural mesothelioma. The article links this cancer to asbestos exposure in industry and construction sites in the 1960s and 1970s. The authors wrote that there had been no randomized trials or even case-matched comparisons of this surgery. They cited a separate published series by Sugarbaker and colleagues of 183 operated patients, in which median survival was 19 months and 15% were alive after 5 years. Because those patients were highly selected, the authors argued this result may not be any better than the natural course of the disease in that same group of patients. They also cited a UK register showing only 26 such operations in 10 centers in 2000–2001. The authors wrote that after 25 years there was no proof either way. They concluded that a trial was needed and described a randomized trial, MARS, funded by Cancer Research UK and due to start.

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 (opinion and discussion article); no original data were collected or analysed
• Who was studied: No study population. The editorial discusses patients with diffuse malignant pleural mesothelioma in general, with reference to the UK and the United States.
• Exposure: The article attributes mesothelioma to asbestos exposure in industry and construction sites in the 1960s and 1970s. No fiber types are named. The treatment discussed is radical surgery, mainly extrapleural pneumonectomy.
• Main results:
  • The authors stated that there had been no randomized trials or even case-matched comparisons of radical surgery for mesothelioma.
  • The authors cited a separate published series by Sugarbaker and colleagues of 183 patients operated on over 18 years. In that series median survival was 19 months and 15% were alive after 5 years. Given the highly selected nature of these patients, the authors argued this result may not be any better than the natural history of the disease in this cohort of patients.
  • The authors cited a UK register: in 2000–2001 only 26 radical extrapleural pneumonectomy operations were performed in 10 UK centers. This was a fall from the previous year, and eight of the centers did just one or two operations.
  • The authors referred to their own earlier work, which found that survival differed by nearly twice between two London tertiary referral hospitals offering similar care. They attributed this to lead time bias in referrals.
  • The authors reported that they had obtained funding from Cancer Research UK for a randomized controlled trial called the Mesothelioma And Radical Surgery (MARS) trial, due to start within months.
• The authors' conclusion: The authors concluded that, after 25 years of selective case series with no proof either way, the way to resolve whether radical surgery helps is to do a trial.

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, Asbestos Exposure.

Related studies

• 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)
• 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)
• Lack of evidence in malignant pleural mesothelioma surgery — O. Rena, C. Casadio (2011)
• Predictors of long-term survival following radical surgery for malignant pleural mesothelioma — A. Nakas, D. Waller (2014)
• The new case for cervical mediastinoscopy in selection for radical surgery for malignant pleural mesothelioma — A. Nakas, D. Waller, et al. (2012)
• How does the timing of chemotherapy affect outcome following radical surgery for malignant pleural mesothelioma? — A.J. Sharkey, K.J. O'Byrne, et al. (2016)

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