Surgery for malignant pleural mesothelioma

Our plain-English summary of Surgery for malignant pleural mesothelioma, by D.J. Sugarbaker, A.S. Wolf (Expert Review of Respiratory Medicine, 2010).

The study

• Authors: D.J. Sugarbaker, A.S. Wolf
• Journal: Expert Review of Respiratory Medicine
• Published: 2010;4(3):363-72
• Type of article: Review
• Cited by: 46 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The role of surgery for malignant pleural mesothelioma encompasses the need for rapid diagnosis, preoperative staging and surgical resection, and also the need for a greater biological understanding of this rare and aggressive malignancy. In the multimodality treatment paradigm, the goal of surgery is to provide a macroscopic complete resection (i.e., complete removal of all grossly visible tumor). Two operations have evolved: extrapleural pneumonectomy and pleurectomy/decortication. The former is indicated for patients with advanced locally invasive disease; the latter for patients with more superficial spread of tumor that spares the lung and fissures. If critical mediastinal structures (e.g., aorta and vertebral bodies) are found to be involved at thoracotomy, the tumor is classified as T4, and pleurectomy/decortication is recommended. Despite having more advanced disease, a subset of patients with favorable prognostic factors can experience extended survival by undergoing trimodality therapy with extrapleural pneumonectomy, chemotherapy and/or radiation. The influence of surgery goes beyond diagnosis and resection. Much of what we know about the biology of mesothelioma has been gleaned from studying the surgical pathophysiology, including the delineation of histopathologic subtypes, disease stage stratification with survival, the propensity for local (in contrast to systemic) recurrence, as well as the prognostic effect of epithelial versus nonepithelial cell type, extrapleural nodal involvement, tumor bulk and surgical margins. Pending the discovery of new drugs, the focus of clinical research over the next 5 years will emphasize refinements in patient selection, pathologic staging, molecular staging and other novel adjuvant therapies.

In plain English

This article was a perspective, a type of review, by two thoracic surgeons at Brigham and Women's Hospital in Boston. It reported no new study. It described surgery for malignant pleural mesothelioma, drawing on published studies, including earlier reports from the authors' own center. It covered two operations. Extrapleural pneumonectomy removes the lung along with the pleura, diaphragm and pericardium on the affected side. Pleurectomy/decortication strips off the pleura and leaves the lung in place. The authors wrote that the aim of surgery is macroscopic complete resection, meaning removal of all visible tumor, followed by other treatment for remaining microscopic disease. Citing other studies, they reported a perioperative death rate for extrapleural pneumonectomy of between 2.2 and 7% at experienced centers, and 3.4% at their center. Median survival in recent studies was 10 to 35 months with extrapleural pneumonectomy-based treatment and 8 to 22 months with pleurectomy/decortication-based treatment. With cisplatin alone or with pemetrexed it was 9.3 to 13.3 months. The authors concluded that research over the next 5 years would focus on patient selection, pathologic and molecular staging, and new adjuvant therapies.

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: Perspective (narrative review) on surgery for malignant pleural mesothelioma; no new data
• Who was studied: No study population of its own; the authors discussed published reports on patients having surgery for malignant pleural mesothelioma, including earlier series from their institution (Brigham and Women's Hospital, Boston)
• Exposure: The article is about surgical treatment, not exposure; asbestos is mentioned only in passing, and no fiber types are discussed
• Main results:
  • Citing other studies, perioperative mortality for extrapleural pneumonectomy at experienced, high-volume centers was between 2.2 and 7%
  • The authors cited their center's earlier report that mortality for extrapleural pneumonectomy had been reduced to 3.4%
  • In their previously reported series, reversible atrial fibrillation occurred in 44.2% of extrapleural pneumonectomy patients
  • Citing recent series, perioperative mortality for pleurectomy ranged from 1 to 5%
  • Citing recent studies, median overall survival with extrapleural pneumonectomy-based multimodality therapy was 10 to 35 months
  • Citing other studies, median survival with pleurectomy/decortication-based multimodality therapy was 8 to 22 months
  • Citing a Phase III trial, median survival with cisplatin chemotherapy alone or with pemetrexed was 9.3 to 13.3 months; historical palliative controls had 7 months
  • In the authors' 1999 series, 31 patients with negative pleural margins, negative extrapleural nodes and epithelial histology had a median survival of 51 months with trimodality therapy
  • Up to 25% of patients judged operable by current methods were found to be unresectable at thoracotomy
• The authors' conclusion: The authors concluded that clinical research over the next 5 years would emphasize refining patient selection, pathologic staging, molecular staging and other novel adjuvant therapies

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Staging, Surgical Resection, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D), Mediastinal Structures, Thoracotomy, Trimodality Therapy.

Related studies

• Multimodal therapy of malignant pleural mesothelioma: is the replacement of radical surgery imminent? — J. Lindenmann, V. Matzi, et al. (2013)
• Multimodality treatment of malignant pleural mesothelioma with or without immunotherapy: does it change anything? — M. Lucchi, A. Picchi, et al. (2010)
• Clinical indications and results after chest wall resection for recurrent mesothelioma — B.M. Burt, S.O. Ali, et al. (2013)
• Chest wall resection for mesothelioma recurrence after surgery — P. Bertoglio, O. Fanucchi, et al. (2016)
• 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)
• Does surgery improve survival of patients with malignant pleural mesothelioma?: a multicenter retrospective analysis of 1365 consecutive patients — P. Bovolato, C. Casadio, et al. (2014)

Browse more research in Expert Review of Respiratory Medicine, or return to medical research.