Surgical Management of Malignant Pleural Mesothelioma: An Update of Clinical Evidence

Our plain-English summary of Surgical Management of Malignant Pleural Mesothelioma: An Update of Clinical Evidence, by C. Cao, Z. Akhunji, B. Fu, et al (Seminars in Thoracic and Cardiovascular Surgery, 2015).

The study

• Authors: C. Cao, Z. Akhunji, B. Fu, C. Wilcox, E. Novis, D.H. Tian, T.D. Yan
• Journal: Seminars in Thoracic and Cardiovascular Surgery
• Published: 2015;27(1):6-8
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

To investigate the surgical management of malignant pleural mesothelioma, 2 randomized controlled trials have been completed. We discuss the findings from these trials and the current evidence of various surgical techniques to treat this challenging disease.

Copyright © 2015 Elsevier Inc. All rights reserved.

In plain English

This article was an editorial, not an original study. It commented on the MesoVATS randomized trial of surgery for malignant pleural mesothelioma, which compared video-assisted thoracoscopic partial pleurectomy (VAT-PP) with talc pleurodesis in 196 patients. As the editorial described it, that trial found that overall survival at 1 year was not statistically significantly different between the two groups. The estimated mean cost of VAT-PP over 12 months was about 3800 pounds higher. The authors criticized the trial on several points. It did not require tissue confirmation before randomization, so 11% of patients who had VAT-PP had benign disease or other cancers. The pleurodesis group mixed two different techniques. Only 71 of 171 analysed patients completed 1-year quality-of-life scores. The authors also discussed the earlier MARS trial of extrapleural pneumonectomy and summarized survival figures from systematic reviews of other operations. They concluded that the MesoVATS findings should be viewed with caution, and that patients needing partial pleurectomy should not be declined VAT-PP based on this trial. The article did not address asbestos exposure.

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 commenting on published randomized trials and systematic reviews of surgery for malignant pleural mesothelioma; no new data were collected
• Who was studied: No study population of its own. The editorial discussed the MesoVATS trial, which, as described here, recruited 196 patients from 12 hospitals over a decade (VAT-PP n = 98, talc pleurodesis n = 98). It also discussed the MARS trial of extrapleural pneumonectomy.
• Main results:
  • MesoVATS trial, as reported by the editorial: overall survival at 1 year was not statistically significantly different between the VAT-PP and talc pleurodesis groups.
  • MesoVATS trial, as reported by the editorial: the estimated mean cost of VAT-PP treatment and follow-up care at 12 months was approximately 3800 pounds more than talc pleurodesis.
  • The editorial's criticism of MesoVATS: histological confirmation was not required before randomization, and VAT-PP was performed on 11% of patients who had benign disease or non-mesothelioma malignancies.
  • The editorial's criticism of MesoVATS: the pleurodesis group combined talc slurry (n=35) and thoracoscopic poudrage (n=34).
  • The editorial's criticism of MesoVATS: only 71 of 171 analysed patients completed their functional scale scores at 1 year.
  • MARS trial, as described by the editorial: 16 of 24 patients assigned to extrapleural pneumonectomy (EPP) completed the procedure, and operative mortality was 18% for patients who underwent EPP per protocol.
  • Other studies cited by the editorial: systematic reviews of prospective trimodality therapy studies (neoadjuvant chemotherapy, EPP and adjuvant radiotherapy) reported median survival of 16.8 to 25.5 months and perioperative mortality of 0 to 5%.
  • Other studies cited by the editorial: a systematic review found that extended pleurectomy/decortication achieved median overall survival of 11.5 to 31.7 months.
• The authors' conclusion: The authors concluded that the MesoVATS trial's design, analysis and interpretation should be viewed with caution, and that patients who require partial pleurectomy/decortication should not be declined VAT-PP based on this trial.
• Limitations the authors state:
  • Regarding the evidence on extended pleurectomy/decortication, the authors noted a paucity of randomized controlled data and that survival benefits may be multi-factorial.

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

• Current surgical strategies for malignant pleural mesothelioma — T. Takuwa, S. Hasegawa (2016)
• Diagnostic surgical pathology in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines — A.M. Schwartz, M.K. Rezaei (2013)
• The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence — P. Bertoglio, D.A. Waller (2016)
• A Clinical Trial of TumorGlow to Identify Residual Disease During Pleurectomy and Decortication — J.D. Predina, A.D. Newton, et al. (2019)
• Surgical management of malignant pleural mesothelioma — J. Yanagawa, V. Rusch (2013)
• A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma — C. Cao, D. Tian, et al. (2014)

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