Standardizing Surgical Treatment of Malignant Pleural Mesothelioma

Our plain-English summary of Standardizing Surgical Treatment of Malignant Pleural Mesothelioma, by D.A. Waller, R. Bilancia, A. Bille, et al (Journal of Thoracic Oncology, 2020).

The study

• Authors: D.A. Waller, R. Bilancia, A. Bille, S. Tenconi
• Journal: Journal of Thoracic Oncology
• Published: 2020;15(5):e73-e74
• Type of article: Letter, Comment
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This was a letter to the editor, not a research study, and it reported no new patient data. Four thoracic surgeons from United Kingdom hospitals responded to a published statement by Friedberg et al. on standardizing surgery for malignant pleural mesothelioma. The authors argued that whenever the chest is opened, the aim should be macroscopic complete resection, meaning removal of all visible tumor, and that this should not be compromised for perceived functional benefit. They wrote that the concern that removing the diaphragm (phrenectomy) might seed tumor in the peritoneum is not supported by factual evidence. They cited an earlier randomized trial by other researchers as indicating a lack of survival benefit from partial pleurectomy, an R2 resection. They argued that total visceral pleurectomy is indicated and that R2 resection should never be intended. They noted that the benefit of pleurectomy decortication remains unproven while the Mesothelioma and Radical Surgery 2 trial is awaited. They supported a quantitative standard operative record and proposed that European and Asian surgeons contribute to an international consensus.

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 (opinion and commentary responding to a published article; no new data)
• Who was studied: None. No patients or data were studied. The letter responds to a published proposal on surgical treatment of malignant pleural mesothelioma.
• Exposure: Not applicable. The letter discusses surgical approaches (pleurectomy decortication, extent of resection), not asbestos exposure.
• Main results:
  • The authors argued that the intent of open surgery should be macroscopic complete resection (MCR).
  • The authors argued that MCR should not be given up for perceived functional benefit.
  • The authors stated that the concern that phrenectomy may seed tumor in the peritoneum lacks factual evidence.
  • The authors cited randomized evidence from another study (the MesoVATS trial in their reference list) indicating a lack of survival benefit from partial pleurectomy (R2 resection).
  • The authors argued that total visceral pleurectomy is indicated if MCR is the intent.
  • The authors argued that an R2 resection should never be an intended outcome, and that subdividing R2 resections is unnecessary.
  • The authors noted that the benefit of pleurectomy decortication is not yet proven, pending the Mesothelioma and Radical Surgery 2 trial, which they said should not be read as a trial of palliative surgery.
  • The authors supported adopting a quantitative standard operative record.
  • The authors noted that the original document reflected North American experts, and proposed that European and Asian surgeons be invited to contribute.
• The authors' conclusion: The authors concluded that agreement is needed on surgical intent from the outset: if the chest is opened, all visible tumor should be removed.

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.

Related studies

• A Proposed System Toward Standardizing Surgical-Based Treatments for Malignant Pleural Mesothelioma, From the Joint National Cancer Institute-International Association for the Study of Lung Cancer-Mesothelioma Applied Research Foundation Taskforce — J.S. Friedberg, M.J. Culligan, et al. (2019)
• Reply to Waller et al. Standardizing Surgical Treatment for Mesothelioma — J.S. Friedberg, M.J. Culligan, et al. (2020)
• A proposal of Brazilian Society of Surgical Oncology (BSSO/SBCO) for standardizing cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in Brazil: pseudomixoma peritonei, appendiceal tumors and malignant peritoneal mesothelioma — T.P. Batista, B.J.Q. Sarmento, et al. (2017)
• Treatment of malignant pleural mesothelioma with chemotherapy preceding versus after surgical resection — V. Verma, C.A. Ahern, et al. (2019)
• The Use of Radiation Therapy for the Treatment of Malignant Pleural Mesothelioma: Expert Opinion from the National Cancer Institute Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer, and Mesothelioma Applied Research Foundation — D.R. Gomez, A. Rimner, et al. (2019)
• A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma — C. Cao, D. Tian, et al. (2014)

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