What is the best approach for surgery of malignant pleural mesothelioma? It is to put our efforts into obtaining trustworthy evidence for practice

Our plain-English summary of What is the best approach for surgery of malignant pleural mesothelioma? It is to put our efforts into obtaining trustworthy evidence for practice, by T. Treasure (The Journal of Thoracic and Cardiovascular Surgery, 2016).

The study

• Author: T. Treasure
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2016;151(2):307-9
• Type of article: Editorial
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

It is accepted that however radical and expertly done, surgery cannot eradicate mesothelioma and therefore cannot realistically be expected to cure the disease other than in a vanishingly few atypical cases. This is implicit in the adoption of ‘‘macroscopic complete resection’’ as the surgical objective. Because of the nature of the disease and the multiplicity of treatment protocols, defining the direction and magnitude of a survival difference cannot be determined from personal experience, follow-up studies or other methods lacking rigorous control data. Several randomized trials including surgery have been and are being carried out, so ‘‘can’t be done’’ is not a defensible position. Independently run multicenter trials are needed.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This is an expert opinion article, not a new study, and it reports no new patient data. The author, from University College London, wrote about surgery for malignant pleural mesothelioma. The author argued that surgery cannot eradicate mesothelioma, and that whether it lengthens survival cannot be judged from personal experience or from uncontrolled case series. To support this, the author cited other published work. In one cited randomized study (MARS), patients eligible for extrapleural pneumonectomy (EPP) but randomly assigned not to have it survived a median of 19.5 months. The author said this was longer than in reported EPP series from the same period. The author also cited analyses in which no survival difference with surgery was evident, a prospective study reporting that EPP harmed quality of life, and comparative studies in which patients having lung-sparing pleurectomy and decortication had no worse survival than those having EPP. The author criticized letting surgeons alone judge "macroscopic complete resection." The author concluded that independently run multicenter randomized controlled trials are 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: Expert opinion article. It argues from previously published studies and presents no new data.
• Who was studied: No study population. The article discusses published evidence on surgery for patients with malignant pleural mesothelioma.
• Exposure: Not asbestos exposure. The article concerns surgical treatment of malignant pleural mesothelioma: extrapleural pneumonectomy (EPP) and lung-sparing pleurectomy and decortication.
• Main results:
  • The author cited the MARS randomized study. Patients eligible for EPP but randomly assigned not to undergo it survived a median of 19.5 months, which the author described as longer than in reported EPP series of the same period.
  • The author cited a cancer registry analysis. After patients outside the comparable range of age, histologic type and performance status were excluded, a survival difference with EPP was not evident.
  • The author cited a more cautious analysis of 945 patients. It showed no survival differences between patients who had resection, those opened and closed, and those turned down for surgery.
  • The author cited comparative studies in which patients having lung-sparing pleurectomy and decortication had no worse survival than those having EPP.
  • The author cited a prospective study in which EPP had an adverse effect on quality of life, from which patients did not live long enough to recover.
  • The author argued that it is methodologically unsound for only the surgeon to judge "macroscopic complete resection."
• The authors' conclusion: The author concluded that independently run multicenter randomized controlled trials are needed to show what surgery achieves in malignant pleural mesothelioma.

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, Mesothelioma.

Related studies

• Lack of evidence in malignant pleural mesothelioma surgery — O. Rena, C. Casadio (2011)
• Pleurectomy decortication for mesothelioma: The procedure of choice when possible — R.M. Flores (2016)
• Current controversies regarding the role of asbestos exposure in the causation of malignant mesothelioma: the need for an evidence-based approach to develop medicolegal guidelines — A.M. Marchevsky, M.R. Wick (2003)
• 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)
• Obtaining an upper estimate of the survival benefit associated with surgery for mesothelioma — M. Utley, F. Fiorentino, et al. (2010)
• The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence — P. Bertoglio, D.A. Waller (2016)

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