Some Mesothelioma Patients May Benefit from Second Radical SurgeryResearch & Clinical Trials
Written by Tim Povtak
Asbestos.com is the nation’s most trusted mesothelioma resource
The Mesothelioma Center at Asbestos.com has provided patients and their loved ones the most updated and reliable information on mesothelioma and asbestos exposure since 2006.
Our team of Patient Advocates includes a medical doctor, a registered nurse, health services administrators, veterans, VA-accredited Claims Agents, an oncology patient navigator and hospice care expert. Their combined expertise means we help any mesothelioma patient or loved one through every step of their cancer journey.
More than 30 contributors, including mesothelioma doctors, survivors, health care professionals and other experts, have peer-reviewed our website and written unique research-driven articles to ensure you get the highest-quality medical and health information.
About The Mesothelioma Center at Asbestos.com
- Assisting mesothelioma patients and their loved ones since 2006.
- Helps more than 50% of mesothelioma patients diagnosed annually in the U.S.
- A+ rating from the Better Business Bureau.
- 5-star reviewed mesothelioma and support organization.
My family has only the highest compliment for the assistance and support that we received from The Mesothelioma Center. This is a staff of compassionate and knowledgeable individuals who respect what your family is experiencing and who go the extra mile to make an unfortunate diagnosis less stressful. Information and assistance were provided by The Mesothelioma Center at no cost to our family.LashawnMesothelioma patient’s daughter
How to Cite Asbestos.com’s Article
Povtak, T. (2023, September 27). Some Mesothelioma Patients May Benefit from Second Radical Surgery. Asbestos.com. Retrieved November 30, 2023, from https://www.asbestos.com/news/2021/03/17/second-mesothelioma-surgery-benefits/
Povtak, Tim. "Some Mesothelioma Patients May Benefit from Second Radical Surgery." Asbestos.com, 27 Sep 2023, https://www.asbestos.com/news/2021/03/17/second-mesothelioma-surgery-benefits/.
Povtak, Tim. "Some Mesothelioma Patients May Benefit from Second Radical Surgery." Asbestos.com. Last modified September 27, 2023. https://www.asbestos.com/news/2021/03/17/second-mesothelioma-surgery-benefits/.
As overwhelming as major surgery for malignant pleural mesothelioma can be, there is a small cohort of patients who still would benefit from a second aggressive operation following the almost inevitable cancer recurrence.
There are tangible returns, according to a recent study. Extended survival and better quality of life still can be attained.
“A second surgery for mesothelioma is not out of the question,” thoracic surgeon Dr. Hany Hasan Elsayed, Faculty of Medicine, Ain Shams University in Cairo, Egypt, told The Mesothelioma Center at Asbestos.com. “I’m not saying it’s common – or should be done for all – but with the right criteria, there can be benefits for a patient.”
Elsayed is the lead author in a first-of-its kind international study that includes a few cases handled originally by legendary mesothelioma specialist Dr. David Sugarbaker.
In the report, authors detailed the factors that could justify a questionable, second mesothelioma surgery for this rare and incurable disease – and the tangible results.
Oxford University Press published the study on behalf of the European Association for Cardio-Thoracic Surgery in January.
“There are cancer centers – some very good ones, too – that even debate the wisdom of a first radical surgery for mesothelioma. There is no real consensus,” Elsayed said. “But we found factors, that if present, can lead to better chances of benefiting from a second operation.”
Mesothelioma Patient Selection Critically Important
The authors identified three key factors that improve chances of second-surgery success:
- A longer-than-normal, disease-free interval after the first procedure
- Epithelial cell type of mesothelioma, not sarcomatoid or biphasic cell types
- Localized recurrence rather than diffused recurrence.
“If the recurrence is diffused, you’re usually not going to improve quality of life with a second surgery, but only cause more pain,” Elsayed said. “The survival benefit won’t be there, so it’s probably not the right thing to do.”
Patients who are healthier overall, and typically younger, naturally have a much better chance of benefiting.
Elsayed said one reason for the study initially was the fact that his University Hospital in Cairo is among the leaders in mesothelioma treatment in the Middle East. It also is close to where a number of manufacturing plants used asbestos, a primary cause of mesothelioma cancer. The hospital, though, has handled only a handful of second surgeries.
Within the U.S. there are several specialty centers today doing the most aggressive surgeries, but only a few offering the option of a second radical surgery after recurrence.
Fewer than a third of patients diagnosed initially with pleural mesothelioma even qualify for a first aggressive surgery, and only a fraction of those return for a second surgery after recurrence.
“This study should elicit a call of hands for centers to share their experiences, to say either do it, or not do it,” Elsayed said. “Right now, you just don’t find a good number of centers doing that second operation.”
Earlier Mesothelioma Surgery Studies
This most recent report focused on three smaller studies totaling 40 patients involved in a second major surgery with a curative intent for mesothelioma.
In the first group of 16 patients, there was a median survival of 20.4 months after the second surgery for those with epithelial cell type, but only 7.4 months survival for those with biphasic subtype.
For the epithelial group whose recurrence didn’t occur until 24 months or longer, the median survival was 35.8 months, compared to those with a recurrence within 12 months whose median survival was only 8.9 months.
In the second group of 16 undergoing a second surgery, two patients died before leaving the hospital. The other 14 had a median survival of 16 months. This was compared to a nine-month survival for patients receiving only follow-up chemotherapy without a second surgery, and only two months for those receiving no therapy after recurrence.
The third group of only eight patients had a median survival of 14.5 months after the second major surgery.
“There is no real solid evidence regarding a second surgery, but I think you could say it’s not out of the question for mesothelioma,” Elsayed said. “I think for patients, if your doctor sees the favorable factors, then you might see significant benefit.”