A team of researchers at the Hyogo College of Medicine in Nishinomiya, Japan, studied the outcomes for pleural mesothelioma patients who received surgery at their facility between 2004 and 2016.
The results: More aggressive surgery did not help mesothelioma patients live longer.
“We showed that introducing less-invasive surgical techniques could decrease surgical risks without compromising survival,” the researchers wrote in their study, published in January in Seminars in Thoracic and Cardiovascular Surgery. “Surgery that is less invasive than conventional extrapleural pneumonectomy could achieve lower surgical risk without compromising survival in patients with malignant pleural mesothelioma.”
The focus on finding less-invasive and better-tolerated pleural mesothelioma surgery techniques is important for improving outcomes of patients diagnosed with this asbestos-related cancer.
In the study, researchers collected information on nearly every mesothelioma patient scheduled to undergo surgery at their facility between April 2004 and July 2016.
Of the 152 patients, 117 received one of three surgical procedures:
Nearly all of the patients — 92 percent of them — were diagnosed with epithelial cell mesothelioma.
All but three patients received neoadjuvant chemotherapy, which is given prior to surgery.
Nearly all patients (95 percent) achieved macroscopic complete resection. The median survival varied significantly between group 1 and groups 2 and 3.
Not all patients are eligible for surgery, but it remains an important treatment option for many pleural mesothelioma patients.
Whether or not a person is a surgical candidate depends on several factors.
According to the 2018 American Society of Clinical Oncology pleural mesothelioma treatment guidelines, some of the most important considerations are cardiopulmonary function, extent of disease within and outside of the chest and ability to receive multimodal therapy.
The research findings support a “less is more” approach for many pleural mesothelioma surgical patients.
However, there are important caveats the study authors noted about the study.
First, it was a retrospective study, which means patient medical records were reviewed for data, rather than collected in real time.
This approach means the surgical techniques varied by time, rather than patients being randomly assigned to a surgery type.
Group 1 included patients treated between 2004 and 2009. Group 2 included patients seen after 2009, when a less-invasive version of the extrapleural pneumonectomy was introduced.
Patients in group 3 were treated from 2012 through 2016, after the least-invasive pleurectomy and decortication procedure became the norm for pleural mesothelioma surgery at this treatment facility.
The authors also caution against assuming their results apply to all groups of mesothelioma patients.
“Japanese centers operate earlier for patients with MPM [malignant pleural mesothelioma] when compared with U.S. and European centers,” the authors wrote. “It is unclear whether our experience with less-invasive, organ-sparing techniques can be applied directly to patients with more advanced MPM.”
The most recent American Society of Clinical Oncology guidelines recommend the majority of patients should receive the less-aggressive, lung-sparing pleurectomy and decortication procedure.