Surgery and mesothelioma: if not randomization, at least standardization and registration!

Our plain-English summary of Surgery and mesothelioma: if not randomization, at least standardization and registration!, by H. Pass (Lung Cancer, 2011).

The study

• Author: H. Pass
• Journal: Lung Cancer
• Published: 2011;71(1):1-2
• Type of article: Editorial
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this editorial, the author discussed how to answer questions about the surgical management of malignant pleural mesothelioma (MPM). He listed what he considered established facts: staging before surgery was unreliable, surgical mortality at high-volume centers had fallen, surgery alone was insufficient, morbidity remained high but manageable at experienced centers, and intrapleural therapies needed further refinement. He noted that a complete (R0) resection was possible in about 8% of cases, and that maximal cytoreduction lacked objective criteria for residual disease. He commented on a study by Bolukbas and colleagues of lung-sparing radical pleurectomy/decortication in 35 patients. Of these, 16 (46%) had Stage I/II disease, only 4 had extended operations, and median survival was 37 months for Stage I/II and 23 months for Stage III/IV. He argued that these results reflected patient selection. He doubted that a randomized trial comparing extrapleural pneumonectomy with radical pleurectomy/decortication was feasible. Instead, he called for standardized surgical terms, standardized pathology interpretation, prospective reporting of complications and adjunctive therapies, and a joint International Mesothelioma Interest Group and IASLC prospective registry. He also called for biomarker studies and archives of tissue and body fluids. He concluded that surgery was an important part of therapy for selected individuals, while acknowledging the lack of consensus in 2010. The author disclosed a pending patent on a microRNA for mesothelioma prognosis.

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, not a research study, and it reported no new data. The author discussed surgery for malignant pleural mesothelioma and argued that the field lacks agreed definitions of the operations used, such as maximal cytoreduction and "radical" pleurectomy decortication. The author commented on a separate paper by Bolukbas and colleagues. In that study, 16 of 35 patients (46%) were Stage I/II and only 4 had "extended" operations. Median survivals there were 37 months for Stage I/II and 23 months for Stage III/IV. The author attributed those results to careful patient selection. The author did not think a randomized trial could settle whether extrapleural pneumonectomy or radical pleurectomy decortication is better. Instead, the author called for standard surgical terms, standard pathology reporting, and prospective reporting of complications. The author also proposed a joint international prospective registry. The author described surgery for selected individuals as "an incredibly important component" of their therapy, while acknowledging a lack of consensus in 2010 about who benefits most and how extensive surgery should be.

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 piece); no original data
• Who was studied: No study population; the editorial concerns the surgical management of patients with malignant pleural mesothelioma (MPM)
• Main results:
  • The author argued that the endpoints of a maximal cytoreduction operation need to be defined, or that there need to be ways to estimate the volume of disease left after surgery
  • Commenting on a separate study by Bolukbas and colleagues (not this article's data): 16 of 35 patients (46%) in that study were Stage I/II
  • In the same Bolukbas study, according to the author, only 4 patients had "extended" operations
  • In the same Bolukbas study, median survivals were 37 months for Stage I/II and 23 months for Stage III/IV; the author attributed this to patient selection
  • The author identified patient selection as the key point
  • The author did not think a randomized trial could answer whether extrapleural pneumonectomy or radical pleurectomy decortication is better
  • The author called for standardized surgical terms and a joint International Mesothelioma Interest Group and International Association for the Study of Lung Cancer prospective registry
• The authors' conclusion: The author stated that surgery for selected individuals with mesothelioma is an incredibly important component of their therapy
• Limitations the authors state:
  • The author acknowledged not knowing which patients benefit most or how extensive surgery should be, and noted a lack of consensus in 2010

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, Pleural Mesothelioma, Staging, High-Volume Center, Cytoreductive Surgery, Pleurectomy/Decortication (P/D), Median Survival, Extrapleural Pneumonectomy (EPP).

Related studies

• No causal association between pneumoconiosis and three inflammatory immune diseases: a Mendelian randomization study — Y.J. Du, Z.W. Lu, et al. (2024)
• Radiologic Considerations and Standardization of Malignant Pleural Mesothelioma Imaging Within Clinical Trials: Consensus Statement from the NCI Thoracic Malignancy Steering Committee - International Association for the Study of Lung Cancer - Mesothelioma Applied Research Foundation Clinical Trials Planning Meeting — R.R. Gill, A.S. Tsao, et al. (2019)
• Pathologic Considerations and Standardization in Mesothelioma Clinical Trials — M.S. Tsao, M. Carbone, et al. (2019)
• Progress of research on microRNAs with diagnostic value in asbestos exposure: A call for method standardization — L. Micolucci, M.R. Rippo, et al. (2017)
• Commentary: Surgical standardization in mesothelioma trials — V.W. Rusch (2022)
• Cancer in electrical workers: an analysis of cancer registrations in England, 1981-87 — N.T. Fear, E. Roman, et al. (1996)

Browse more research in Lung Cancer, or return to medical research.