Surgical management of malignant pleural mesothelioma: impact of surgery on survival and quality of life-relation to chemotherapy, radiotherapy, and alternative therapies

Our plain-English summary of Surgical management of malignant pleural mesothelioma: impact of surgery on survival and quality of life-relation to chemotherapy, radiotherapy, and alternative therapies, by S. Papaspyros, S. Papaspyros (ISRN Surgery, 2014).

The study

• Authors: S. Papaspyros, S. Papaspyros
• Journal: ISRN Surgery
• Published: 2014;2014:817203
• Type of article: Review
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction. Malignant pleural mesothelioma (MPM) is an aggressive cancer arising from pleural mesothelium. Surgery aims to either cure the disease or control the symptoms. Two surgical procedures exist: extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). In this systematic review we assess current evidence on safety and efficacy of surgery. Methods. Five electronic databases were reviewed from January 1990 to January 2013. Studies were selected according to a predefined protocol. Primary endpoint was overall survival. Secondary endpoints included quality of life, disease-free survival, disease recurrence, morbidity, and length of hospital stay. Results. Sixteen studies were included. Median survival ranged from 8.1 to 32 months for P/D and from 6.9 to 46.9 months for EPP. Perioperative mortality was 0%-9.8% and 3.2%-12.5%, respectively. Perioperative morbidity was 5.9%-55% for P/D and 10%-82.6% for EPP. Average length of stay was 7 days for P/D and 9 days for EPP. Conclusion. Current evidence cannot definitively answer which procedure (EPP or P/D) is more beneficial in terms of survival and operative risks. This systematic review suggests that surgery in the context of trimodality therapy offers acceptable perioperative outcomes and long-term survival. Centres specialising in MPM management have better results.

In plain English

This article is a systematic review of published studies on surgery for malignant pleural mesothelioma. The authors searched five databases (PubMed, Ovid, two Cochrane databases and Web of Science) for English-language studies from January 1990 to January 2013. They looked at two operations: extrapleural pneumonectomy (EPP), which removes the lung on the affected side together with the pleura, diaphragm and pericardium, and pleurectomy/decortication (P/D), a more limited operation. Most included studies were single-centre retrospective reviews, and only one randomised controlled trial was found. Across the P/D studies, median survival ranged from 8.1 to 32 months, deaths around the time of surgery from 0% to 9.8%, and complications from 5.9% to 55%. Across the EPP studies, median survival ranged from 6.9 to 46.9 months, deaths around the time of surgery from 3.2% to 12.5%, and complications from 10% to 82.6%. The authors said this large variability made safe conclusions difficult. They concluded that both operations can be done with acceptable perioperative mortality in specialised centres, but that evidence for long-term survival is inconsistent.

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: Systematic review of published studies (mostly retrospective series, some prospective and phase II trials, one randomised controlled trial)
• Who was studied: Published studies of adults with histologically proven malignant pleural mesothelioma treated with EPP or P/D, found in five electronic databases from January 1990 to January 2013. Limited to human subjects, English language, and studies with more than 20 participants.
• Exposure: Not an asbestos exposure study. The intervention reviewed was surgery (extrapleural pneumonectomy or pleurectomy/decortication), alone or with chemotherapy and/or radiotherapy before or after the operation.
• Main results:
  • Across the P/D studies, median survival ranged from 8.1 to 32 months.
  • Across the P/D studies, perioperative mortality ranged from 0% to 9.8% and perioperative morbidity from 5.9% to 55%.
  • Across the EPP studies, median survival ranged from 6.9 to 46.9 months.
  • Across the EPP studies, perioperative mortality ranged from 3.2% to 12.5% and perioperative morbidity from 10% to 82.6%.
• The authors' conclusion: The authors concluded that EPP and P/D can be performed with acceptable perioperative mortality in specialised centres. They added that evidence for long-term survival with trimodality therapy is inconsistent, and that there is no evidence-based answer as to which procedure is more appropriate.
• Limitations the authors state:
  • Few randomised trials existed, so retrospective series and nonrandomised trials had to be included.
  • Patient selection varied between and within institutions over time.
  • Changes over time in staging systems and in definitions of P/D and EPP made comparison of results between studies extremely difficult.
  • The large variability in results made it difficult to reach safe conclusions about the efficacy and safety of each procedure.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Quality of Life, Chemotherapy, Mesothelium, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D), Systematic Review, Overall Survival.

Related studies

• Impact of Major Complications on Patients' Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy — T.D. Hamilton, E.L. Taylor, et al. (2016)
• Peritoneal carcinomatosis: patients selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — G. Glockzin, H.J. Schlitt, et al. (2009)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk? — N. Tsilimparis, C. Bockelmann, et al. (2013)
• Addition of radiotherapy to surgery and chemotherapy improves survival in localized malignant pleural mesothelioma: A Surveillance, Epidemiology, and End Results (SEER) study — A.B. Thompson, T.J. Quinn, et al. (2020)
• Evaluating quality of life and cost implications of prophylactic radiotherapy in mesothelioma: Health economic analysis of the SMART trial — S.A. Stewart, A.O. Clive, et al. (2018)

Browse return to medical research.