The use of surgery in mesothelioma

Our plain-English summary of The use of surgery in mesothelioma, by J.Y. Lim, A.S. Wolf, R.M. Flores (The Lancet. Respiratory Medicine, 2013).

The study

• Authors: J.Y. Lim, A.S. Wolf, R.M. Flores
• Journal: The Lancet. Respiratory Medicine
• Published: 2013;1(3):184-6
• Read it: PubMed · Publisher

In plain English

This short commentary summarized earlier research, some by the authors, on surgery for malignant pleural mesothelioma; it was not an original study. The authors, from Mount Sinai Medical Center in New York, noted that this cancer is associated with environmental exposure to fibrous minerals such as asbestos or erionite. They described two operations: extrapleural pneumonectomy (EPP), removing the lung, pleura, diaphragm and pericardium, and pleurectomy/decortication (P/D), which preserves the lung. A cited retrospective study of 663 patients, operated on as part of a multimodality treatment plan aimed at cure, found higher survival with P/D for early-stage disease and with EPP for later-stage disease. Among 42 stage III patients given P/D and adjuvant chemoradiation in a cited study, median survival was 35 months for the 26 (62%) whose visible tumour was completely removed and 13 months for the 16 with incomplete removal. They stated that operative death rates are now 2.2 to 7% for EPP and 1 to 5% for P/D. The authors concluded that, if all visible tumour can be removed, the choice of operation depends on each patient's tumour and functional status.

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: Commentary (a 'Comment' piece in The Lancet Respiratory Medicine) summarizing published studies and guidelines on surgery for malignant pleural mesothelioma; no new data were collected
• Who was studied: No study population of its own; the commentary discussed patients with malignant pleural mesothelioma as described in earlier published studies
• Exposure: Not an exposure study. The subject was surgical treatment (EPP versus P/D). Asbestos and erionite were mentioned only as background causes of the disease; no fiber types or doses were studied.
• Main results:
  • Cited earlier study, not this article's own finding: in a multi-institutional retrospective study of 663 patients, when surgery was undertaken as part of a multimodality treatment plan with curative intent, cumulative survival for early-stage disease was higher with P/D than with EPP. Survival for later-stage disease was higher with EPP.
  • Cited earlier study: 42 patients had International Mesothelioma Interest Group stage III disease and underwent P/D and adjuvant chemoradiation. Complete visible (macroscopic) resection was possible in 26 (62%). Median survival was 35 months in those 26 patients, compared with 13 months in the 16 patients with incomplete resections.
  • Cited earlier study: in a retrospective study of 945 patients, longer survival was associated with epithelial histology, female sex, earlier stage, no history of smoking or asbestos exposure, and left-sided tumours
  • Cited sources: the authors stated that death rates associated with these operations, once prohibitively high, are now 2.2 to 7% for EPP and 1 to 5% for P/D
  • Cited trial: the authors stated that the design of the Mesothelioma and Radical Surgery (MARS) trial of EPP was not feasible because of the high morbidity associated with EPP
• The authors' conclusion: The authors concluded that, as long as macroscopic resection of gross disease can be achieved, the choice between EPP and P/D depends on the individual patient's tumour and functional status. They stated that this view is reflected in the 2012 International Mesothelioma Interest Group Congress guidelines.

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.

Related studies

• The new case for cervical mediastinoscopy in selection for radical surgery for malignant pleural mesothelioma — A. Nakas, D. Waller, et al. (2012)
• Surgery as part of radical treatment for malignant pleural mesothelioma — D.A. Waller, S. Tenconi (2017)
• The management of the diaphragm during radical surgery for malignant pleural mesothelioma — A.J. Sharkey, R. Bilancia, et al. (2016)
• Prognostic coronary surgery in a case of malignant mesothelioma previously managed with trimodality treatment — V. Dhurandhar, B.M. Robinson, et al. (2014)
• A feasibility study evaluating Surgery for Mesothelioma After Radiation Therapy: the "SMART" approach for resectable malignant pleural mesothelioma — B.C. Cho, R. Feld, et al. (2014)
• Clinical impact of extrapleural pneumonectomy for malignant pleural mesothelioma — V. Ambrogi, A. Baldi, et al. (2012)

Browse more research in The Lancet. Respiratory Medicine, or return to medical research.