The mesothelioma surgery shift

Our plain-English summary of The mesothelioma surgery shift, by R.M. Flores (The Journal of Thoracic and Cardiovascular Surgery, 2016).

The study

• Author: R.M. Flores
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2016;151(2):485-6
• Type of article: Editorial, Comment
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this editorial commentary, the author discussed the shift in surgery for malignant pleural mesothelioma from extrapleural pneumonectomy (EPP) to pleurectomy and decortication (PD), responding to a study by Batirel and colleagues in the same issue. He noted that a large multicenter comparison had not shown great survival differences between the two procedures, and that the MARS group had begun a trial comparing PD with nonsurgical treatment. He questioned whether macroscopic complete resection (MCR), which he described as essentially an R1 resection, should be the sole primary goal of surgery. He observed that MCR was championed mainly on the basis of a highly selected study of patients with epithelioid disease who underwent EPP, with a median survival of 18 months. He highlighted two findings from the Batirel study. R1 (MCR) resection fell from 65% to 41% with the shift to PD, and 87% of EPP patients versus 59% of PD patients had epithelioid histology. Yet no survival difference favoring EPP was observed. He suggested that the adverse effects of pneumonectomy may offset the benefits of cytoreduction. These include higher operative and longer-term mortality and quicker death after recurrence. He proposed a risk-benefit equation and concluded that current data favor PD, that a randomized trial was not necessary to answer the question, and that surgeons should remove as much tumor as possible without sacrificing the lung.

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 is an editorial commentary, not an original study. It accompanied a study by Batirel and colleagues from Turkey in the same journal issue. The author described a shift in mesothelioma surgery from extrapleural pneumonectomy (EPP), which removes the lung, to pleurectomy and decortication (PD). The shift followed a large multicenter study that failed to show great survival differences between the two. The author argued that the goal of removing all visible tumor rested mainly on an earlier study. That study included only selected patients with epithelioid disease who had EPP, and it had no comparison group. Citing the Turkish study, the author noted that the move to PD came with a fall in R1 resections from 65% to 41%. In that study, 87% of EPP patients and 59% of PD patients had epithelioid tumors, yet no survival difference favoring EPP was observed. The author suggested that the adverse effects of EPP may offset its benefits. The author concluded that the available data favor PD over EPP and that a randomized trial is not needed. The author added that new drugs could change this in future.

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 (opinion piece discussing published studies; no original data)
• Who was studied: No study population of its own; the commentary discusses published surgical studies of mesothelioma patients, chiefly the Turkish study by Batirel and colleagues in the same issue
• Exposure: No asbestos exposure was studied; the commentary concerns two surgical procedures for mesothelioma, extrapleural pneumonectomy (EPP) and pleurectomy and decortication (PD)
• Main results:
  • The author stated that the shift from EPP to PD followed a large multicenter comparative study that failed to show great survival differences between the two procedures
  • The author described the Sugarbaker study behind the macroscopic complete resection rationale as including only patients with epithelioid disease who underwent EPP, with no comparison group; median survival in that study was 18 months
  • Citing the Batirel study: the shift from EPP to PD was associated with a decrease in R1 (macroscopic complete) resection from 65% to 41%, and 87% of the EPP group had epithelioid histologic type
  • Citing the Batirel study: only 59% of the PD group had epithelioid histologic type, yet no survival difference in favor of EPP was observed
  • The author suggested that the adverse effects of EPP may offset the benefits of the tumor removal it provides
• The authors' conclusion: The author concluded that, on the currently available data including the Batirel study, the risk-benefit balance favors PD rather than EPP, and that a randomized controlled trial is not needed to answer this question, though new drug discoveries may change this in future

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, Extrapleural Pneumonectomy (EPP), Epithelioid, Median Survival, Histology, Pneumonectomy, Cytoreductive Surgery.

Related studies

• Frequency of Surgery in Black Patients with Malignant Pleural Mesothelioma — E. Taioli, A.S. Wolf, et al. (2015)
• 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)
• Intraoperative fluorescence imaging in thoracic surgery — A.D. Newton, J.D. Predina, et al. (2018)
• Surgery for malignant pleural mesothelioma — D.J. Sugarbaker, A.S. Wolf (2010)
• The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence — P. Bertoglio, D.A. Waller (2016)
• A survey of opinions and beliefs concerning surgery for malignant pleural mesothelioma amongst 802 members of the European Association for Cardio-Thoracic Surgery (EACTS), the European Society of Thoracic Surgeons (ESTS) and the Society of Thoracic Surgeons (STS) — T. Treasure, E. Internullo, et al. (2011)

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