Do we still need to debate the merits of pleurectomy/decortication vs. extrapleural pneumonectomy for malignant pleural mesothelioma?

Our plain-English summary of Do we still need to debate the merits of pleurectomy/decortication vs. extrapleural pneumonectomy for malignant pleural mesothelioma?, by A. Nakamura, K. Kuribayashi (Translational Lung Cancer Research, 2023).

The study

• Authors: A. Nakamura, K. Kuribayashi
• Journal: Translational Lung Cancer Research
• Published: 2023;12(2):193-196
• Type of article: Editorial, Comment
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This article was an editorial, not a new study. The authors commented on a published single-institution study by Klotz and colleagues. They discussed two operations for malignant pleural mesothelioma: pleurectomy/decortication (P/D), which spares the lung, and extrapleural pneumonectomy (EPP), which removes it. The editorial did not discuss asbestos exposure. Klotz and colleagues reported a median overall survival of 38.1 months with extended P/D combined with hyperthermic intrathoracic chemotherapy and adjuvant chemotherapy, compared with 24.0 months with trimodal EPP. The authors also cited their own earlier work. In that work, 18 of 181 patients (9.9%) planned for P/D were converted to EPP during surgery. Those converted patients had shorter median overall survival than P/D patients (29.2 vs. 57.0 months), which the authors attributed to more advanced disease stage. The authors noted a lack of prospective randomized studies, so the better technique remained undetermined. They concluded that further research is needed on one question: when unexpected tumor spread into the lung is found during P/D, should surgeons convert to EPP or complete P/D as an R2 resection, which leaves some tumor behind?

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 a published study by Klotz et al.); no new data were collected
• Who was studied: No study population of its own; the editorial discusses published studies of patients with malignant pleural mesothelioma treated with curative-intent surgery
• Exposure: Not asbestos exposure. The editorial compares two operations: lung-sparing pleurectomy/decortication (P/D) and extrapleural pneumonectomy (EPP), which removes the lung, pleura, pericardium and diaphragm
• Main results:
  • Reported by Klotz et al. (the study commented on, not this article), which compared multimodal regimens: median overall survival was 38.1 months in the extended P/D with hyperthermic intrathoracic chemotherapy and adjuvant chemotherapy cohort, 24.0 months in the trimodal EPP cohort and 15.8 months in the chemotherapy-alone cohort
  • Reported by a meta-analysis by Taioli et al. (cited by the authors): short-term deaths were 4.5% in the EPP group vs. 1.7% in the P/D group (P<0.05)
  • From the authors' earlier institutional studies: among 57 patients with recurrence after P/D, 1-year post-recurrence survival was 59.5% (median 14.4 months); among 39 patients with recurrence after EPP, it was 40.0% (median 6.5 months)
  • From the authors' earlier study: 9.9% (18/181) of patients intended for P/D were converted to EPP during surgery
  • From the same earlier study: median overall survival was 29.2 months in patients converted to EPP vs. 57.0 months in patients who had P/D (P<0.01)
• The authors' conclusion: The authors concluded that further research is needed to decide whether to convert to EPP or to complete P/D as an R2 resection when unexpected diffuse tumor invasion into the lung is found during P/D
• Limitations the authors state:
  • There are no prospective randomized studies comparing EPP and P/D, so the better technique remains undetermined
  • In the authors' earlier conversion study, the shorter survival after conversion to EPP may reflect more advanced disease stage in that group

Topics

Medical terms in this study, explained in our Lexicon: Pleurectomy/Decortication (P/D), Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma.

Related studies

• Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma — E. Taioli, A.S. Wolf, et al. (2015)
• Pleurectomy/decortication is superior to extrapleural pneumonectomy in the multimodality management of patients with malignant pleural mesothelioma — L. Lang-Lazdunski, A. Bille, et al. (2012)
• Extrapleural Pneumonectomy Versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma — N. Zhou, D.C. Rice, et al. (2022)
• Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma — S. Hasegawa (2014)
• Systematic review of quality of life following pleurectomy decortication and extrapleural pneumonectomy for malignant pleural mesothelioma — R.M. Schwartz, W. Lieberman-Cribbin, et al. (2018)
• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)

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