Surgery for mesothelioma: Less is more, more or less

Our plain-English summary of Surgery for mesothelioma: Less is more, more or less, by S. Milman, T. Ng (The Journal of Thoracic and Cardiovascular Surgery, 2018).

The study

• Authors: S. Milman, T. Ng
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2018;155(4):1867-1868
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This article was an editorial commentary, not an original study. The authors commented on a separate study by Ambrogi and colleagues in the same journal. According to the commentary, that study described 49 patients with epithelial or biphasic mesothelioma treated at one institution over 10 years with pleurectomy decortication (PD), a less radical operation, plus heated chemotherapy inside the chest and later chemotherapy. The commentary reported that study's findings as no deaths within 90 days, an overall complication rate of 47%, and median overall survival of 22 months. The authors listed weaknesses of that study: few patients, a long study period, no quality-of-life data, and a retrospective, single-group design. They noted that meta-analyses by other researchers found extrapleural pneumonectomy (EPP) had higher mortality and similar survival compared with PD, but those also lacked randomized studies. The authors concluded that PD should be considered first when it can remove all visible tumor, that EPP should not be entirely abandoned, and that higher-level evidence is needed.

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 commentary on another published study (Ambrogi and colleagues); no new data of its own
• Who was studied: Not a study population of its own. The commented-on study by Ambrogi and colleagues involved 49 patients with epithelial or biphasic mesothelioma treated at a single institution over a 10-year period
• Exposure: Not an asbestos exposure study. The commentary concerned the extent of surgery (pleurectomy decortication versus extrapleural pneumonectomy) within multimodality treatment of mesothelioma
• Main results:
  • As reported by the commentary for the Ambrogi study's 49 patients: no 90-day mortality and an overall morbidity rate of 47%
  • As reported by the commentary for the Ambrogi study: median overall survival of 22 months (35 months for stages I and II, 17 months for stages III and IV)
  • As reported by the commentary for the Ambrogi study: 5-year overall survival of 10% and 5-year disease-free survival of 18.5%
  • The authors identified weaknesses in the Ambrogi study: a small number of patients and a long study duration
  • The authors identified further weaknesses in the Ambrogi study: no quality-of-life data, and a retrospective, single-cohort design
  • The commentary cited meta-analyses by Cao and colleagues and by Taioli and colleagues that found EPP had higher mortality and similar overall survival compared with PD. The authors noted that these meta-analyses lacked randomized studies.
  • The authors stated that the only randomized trial comparing PD with EPP (the Mesothelioma and Radical Surgery trial) did not allow a firm conclusion about which was superior, because of that trial's limitations
  • In the authors' view, the less morbid PD should be considered first in preference to EPP, but EPP should not be entirely abandoned until high-level data are available
• The authors' conclusion: The authors concluded that current data increasingly support less radical surgery in the multimodality treatment of mesothelioma, but that a higher level of evidence is needed to confirm this

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: Mesothelioma.

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