Recommendations for uniform definitions of surgical techniques for malignant pleural mesothelioma: a consensus report of the international association for the study of lung cancer international staging committee and the international mesothelioma interest group

Our plain-English summary of Recommendations for uniform definitions of surgical techniques for malignant pleural mesothelioma: a consensus report of the international association for the study of lung cancer international staging committee and the international mesothelioma interest group, by D. Rice, V. Rusch, H. Pass, et al (Journal of Thoracic Oncology, 2011).

The study

• Authors: D. Rice, V. Rusch, H. Pass, H. Asamura, T. Nakano, J. Edwards, D.J. Giroux, S. Hasegawa, K.H. Kernstine, D. Waller, R. Rami-Porta, International Association for the Study of Lung Cancer International Staging Committee and the International Mesothelioma Interest Group
• Journal: Journal of Thoracic Oncology
• Published: 2011;6(8):1304-12
• Type of article: Consensus statement
• Cited by: 206 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Extrapleural pneumonectomy has been well defined; however, surgeons vary regarding the surgical extent and goals of "pleurectomy/decortication" (P/D). We explored mesothelioma surgeons' concepts of P/D with the aim of unifying surgical nomenclature.

Methods: A web-based survey was administered to surgeons who operated on malignant pleural mesothelioma (MPM) for diagnosis, staging, palliation, or cytoreduction. One hundred thirty surgeons from 59 medical centers were included. Surgeons who did not perform surgery for MPM within the last year were excluded.

Results: There were 62 (48%) respondents from 39 medical centers in 14 countries. The mean number of patients with MPM seen annually at each medical center was 46, and the mean annual number of cytoreductive procedures performed per surgeon was 8. Most (88%) agreed that the goal of cytoreductive surgery should be macroscopic complete resection of tumor. P/D was defined as resection of parietal and visceral pleura with the aim of achieving macroscopic complete resection by 72% of respondents. If the diaphragm or pericardium required resection, 64% preferred the term "radical P/D," whereas "P/D" (40%) or "total pleurectomy" (39%) was preferred if these structures were not removed. Most surgeons believed that extrapleural pneumonectomy (90%) or "radical P/D" (68%) could provide adequate cytoreduction, whereas only 23% thought that P/D could.

Conclusions: There was significant variation regarding surgical nomenclature for procedures for MPM. The International Staging Committee of the International Association for the Study of Lung Cancer and the International Mesothelioma Interest Group recommend that P/D should aim to remove all macroscopic tumor involving the parietal and visceral pleura and should be termed "extended" P/D when the diaphragm or pericardium is resected.

In plain English

This consensus report from the International Association for the Study of Lung Cancer (IASLC) International Staging Committee and the International Mesothelioma Interest Group (IMIG) dealt with how surgery for malignant pleural mesothelioma is named. It did not study asbestos exposure. In October 2010 the authors sent a web-based survey to 130 surgeons with an interest in the disease. Of these, 62 (47.7%) responded, from 39 centers in 14 countries, and 58 gave usable answers. Most (95%) felt surgical terms needed refining. Forty-two of 58 (72%) took "pleurectomy/decortication" (P/D) to mean removing all gross tumor from the parietal and visceral pleura. When the diaphragm or pericardium was also removed, 64% called the operation "radical P/D." Most respondents (88%) said cytoreductive surgery should aim to remove all visible or palpable tumor. Asked which operations could do this, 90% chose extrapleural pneumonectomy, 68% "radical P/D" and 23% P/D. The two groups recommended four terms. They favored "extended P/D" over "radical P/D," saying there was insufficient evidence that removing the pericardium and diaphragm gives complete resection or added benefit. The authors noted a response rate under 50% and possible bias toward Western practice.

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: Consensus report based on a web-based survey (questionnaire) of surgeons, followed by committee review and recommendations
• Who was studied: 130 surgeons from 59 centers worldwide who had a clinical or research interest in malignant pleural mesothelioma. 62 (47.7%) responded, from 39 centers in 14 countries, mostly in Europe (47%) and North America (42%). 58 gave analyzable data. The survey ran from October 11 to October 29, 2010.
• Main results:
  • 95% of respondents felt surgical nomenclature needed refining to distinguish palliative P/D from P/D performed for macroscopic complete resection
  • 42 of 58 respondents (72%) considered "P/D" to imply resection of all gross parietal and visceral tumor, with the aim of removing all macroscopic disease
  • When the diaphragm and/or pericardium were resected, 64% of respondents called the procedure "radical P/D"
  • When the diaphragm and pericardium were not resected, 23 respondents (40%) chose "P/D" and 22 (39%) preferred "total pleurectomy"
  • 51 respondents (88%) agreed that the goal of cytoreductive surgery should be removal of all visible or palpable tumor
  • Asked which procedure could provide macroscopic complete resection, 51 respondents (90%) chose extrapleural pneumonectomy, 39 (68%) "radical P/D" and 13 (23%) "P/D"
  • 86% of respondents did not believe video-assisted thoracoscopic surgery could provide as complete a cytoreduction as an open operation
• The authors' conclusion: The IASLC Mesothelioma Domain and the IMIG recommended four terms: extrapleural pneumonectomy, extended P/D, P/D and partial pleurectomy. "Extended P/D" means parietal and visceral pleurectomy to remove all gross tumor with resection of the diaphragm and/or pericardium. They chose "extended" rather than "radical" because they judged there was insufficient evidence that such resection provides completeness of resection or added therapeutic benefit.
• Limitations the authors state:
  • The survey response rate was under 50%
  • Respondents were mainly from North America and Europe, so the findings may be biased toward Western practice

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: Pleural Mesothelioma, Lung Cancer, Staging, Mesothelioma, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D), Cytoreductive Surgery, Visceral Pleura.

Related studies

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• Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group — A.N. Husain, T.V. Colby, et al. (2018)
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