Optimal surgery for resectable malignant pleural mesothelioma in the setting of multimodality treatment

Our plain-English summary of Optimal surgery for resectable malignant pleural mesothelioma in the setting of multimodality treatment, by N. Kondo, S. Hasegawa (Surgery Today, 2024).

The study

• Authors: N. Kondo, S. Hasegawa
• Journal: Surgery Today
• Published: 2024;54(7):663-669
• Type of article: Review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The surgical treatment of malignant pleural mesothelioma (MPM) involves procedures to achieve macroscopic complete resection, depending on the patient's condition. We reviewed the evolution of surgical approaches for resectable MPM. Since surgery is no more than a single step in the set of processes in multimodality treatment (MMT), we concluded that these procedures should give precedence to lung preservation and minimize resection whenever possible. Postoperative quality of life must be prioritized when the patient can receive appropriate adjuvant therapy.

© 2023. The Author(s).

In plain English

This was a review article from the Department of Thoracic Surgery at Hyogo Medical University in Japan about surgery for malignant pleural mesothelioma that can be removed surgically. It did not study asbestos exposure. The authors reviewed two operations used as part of combined treatment: extra-pleural pneumonectomy (EPP), which removes the lung, and pleurectomy/decortication (P/D), which preserves it. They stated that there is no clear evidence that either procedure is better than the other. The authors also reported results for 204 patients who had P/D at their hospital. Of these, 1 of 204 (0.5%) died within 30 days and 4 of 204 (2.0%) within 90 days. Adverse events of grade 3 or higher occurred in 41 patients (20.1%), and 119 patients (58.3%) had an air leak lasting more than 7 days. Median overall survival was 42 months. The authors concluded that surgery should aim to remove all visible tumor with the minimum resection needed, and that keeping a quality of life that allows further treatment is of the utmost importance.

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: Review article (narrative review of surgical approaches), with the authors' own hospital results for P/D added
• Who was studied: Published reports on surgery for resectable malignant pleural mesothelioma, plus 204 patients who underwent P/D at Hyogo Medical University, Japan (median age 67 years, range 16 to 82; 165 men, 80.9%). The period of treatment is not stated.
• Exposure: Not an exposure study. The article concerns surgical procedures (extra-pleural pneumonectomy and pleurectomy/decortication) within multimodality treatment. Asbestos and fiber types are not discussed.
• Main results:
  • Among the 204 P/D patients at the authors' hospital, 30-day mortality was 0.5% (1/204) and 90-day mortality was 2.0% (4/204)
  • Among the 204 P/D patients, grade 3 or higher adverse events occurred in 41 patients (20.1%)
  • Among the 204 P/D patients, an air leak lasting more than 7 days occurred in 119 patients (58.3%)
  • Among all 204 P/D patients, median overall survival was 42 months and median progression-free survival was 12 months
  • From the literature reviewed, the authors stated there is no clear evidence that either EPP or P/D is superior or inferior
• The authors' conclusion: The authors concluded that lung-sparing surgery is part of multimodality treatment and that keeping a quality of life that allows adjuvant therapy and treatment of any recurrence is of the utmost importance.
• Limitations the authors state:
  • The authors stated that retrospective comparisons between the surgical procedures are affected by bias in the patients studied and by uneven differences in multimodality treatment.

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, Quality of Life, Adjuvant Therapy.

Related studies

• Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma — T. Tanaka, S. Morishita, et al. (2017)
• Peritoneal cystic mesothelioma: are surgery and HIPEC optimal first-line treatments? — F. Coccolini, R. Manfredi, et al. (2012)
• Pretreatment serum C-reactive protein levels predict benefit from multimodality treatment including radical surgery in malignant pleural mesothelioma: a retrospective multicenter analysis — B. Ghanim, M.A. Hoda, et al. (2012)
• 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)
• Surgery as part of radical treatment for malignant pleural mesothelioma — D.A. Waller, S. Tenconi (2017)
• Preliminary results of entire pleural intensity-modulated radiotherapy in a neoadjuvant setting for resectable malignant mesothelioma — J.H. Hong, H.C. Lee, et al. (2019)

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