MD Anderson Examines Aggressive Mesothelioma Surgery in Latest StudyResearch & Clinical Trials
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. (2022, January 12). MD Anderson Examines Aggressive Mesothelioma Surgery in Latest Study. Asbestos.com. Retrieved December 3, 2022, from https://www.asbestos.com/news/2021/05/25/md-anderson-mesothelioma-surgery-study/
Povtak, Tim. "MD Anderson Examines Aggressive Mesothelioma Surgery in Latest Study." Asbestos.com, 12 Jan 2022, https://www.asbestos.com/news/2021/05/25/md-anderson-mesothelioma-surgery-study/.
Povtak, Tim. "MD Anderson Examines Aggressive Mesothelioma Surgery in Latest Study." Asbestos.com. Last modified January 12, 2022. https://www.asbestos.com/news/2021/05/25/md-anderson-mesothelioma-surgery-study/.
A retrospective study involving two decades of pleural mesothelioma patients at the heralded University of Texas MD Anderson Cancer Center failed to demonstrate a definitive survival advantage to support regular use of extrapleural pneumonectomy surgery.
The most aggressive surgery possible for this type of mesothelioma – once the surgery of choice – showed no clear benefit over a more conservative procedure.
When compared to the less-aggressive, lung-sparing pleurectomy and decortication surgery, EPP had a much higher perioperative mortality rate and a shorter median survival.
“In a multimodality treatment paradigm, the type of cytoreductive operation for MPM does not define long-term outcomes,” the authors wrote. “We did not find type of operation to be associated with long-term oncological benefits in the overall cohort, or any patient subgroup that we examined. P/D is a much safer operative procedure.”
The Annals of Thoracic Surgery published the study earlier this month. Authors include oncologist Dr. Anne Tsao and thoracic surgeon Dr. David Rice, MD Anderson mesothelioma specialists in Houston.
Use of EPP Declining at Most Treatment Centers
MD Anderson’s status as the No. 1 ranked cancer hospital in America for seven consecutive years added considerable weight to earlier, less extensive studies that had reached similar conclusions and fueled the ongoing debate about whether EPP should continue to be performed.
When aggressive surgery is an option, most mesothelioma patients in recent years have been choosing the pleurectomy and decortication approach.
At MD Anderson, for example, 122 patients underwent EPP surgery from 2000 to 2006, compared to only 19 from 2014 to 2019. During the same period, the P/D numbers jumped from five to 48.
Extrapleural pneumonectomy surgery involves removing the entire diseased lung, the lining around it, parts of the diaphragm and pericardium.
The P/D, which was developed as a less-aggressive alternative, removes the pleural lining around the lung, all visible tumors on the lung and anywhere else in the thoracic cavity.
Although the goal with both is a complete tumor-cell reduction, it is much more difficult to achieve with the P/D surgery.
“Rather than focusing on which procedure is better, it appears that the goal should be to achieve MCR [macroscopic complete resection] using the safest operative method that the patient can tolerate,” the authors wrote.
Type of Surgery Doesn’t Define Long-Term Outcomes
The study involved 282 surgical patients at MD Anderson Cancer Center from 2000 to 2019, including 66% who had the EPP and 34% undergoing P/D.
It also found that, regardless of which surgery was used, epithelioid histology, macroscopic complete resection, adjuvant radiation therapy and more recent operative years were associated with better survival.
|Extrapleural Pneumonectomy||Pleurectomy & Decortication|
|Perioperative Mortality (within 30 days of surgery or same hospital stay)||11%||0%|
||15 months||22 months|
|8.7 months||7.2 months|
Of the 21 perioperative deaths with EPP surgery, seven were attributed to cardiac arrest, six to respiratory failure and five from infection.
EPP patients typically were younger, had a lower median performance status score and were more likely to be smokers.
Perioperative death rates with EPP have varied widely in earlier studies. Renowned thoracic surgeon Dr. David Sugarbaker, who pioneered the procedure at Brigham and Women’s Hospital 20 years ago, reported a 3%-5% mortality rate in his study, but others have reported mortality as high as 18%.
Still A Place for Extrapleural Pneumonectomy
While most earlier studies had similar findings to MD Anderson’s – leading to the significant drop in EPP surgeries in recent years – there has been one definitive exception that continues to intrigue surgeons who still believe in the procedure.
The Princess Margaret Cancer Center in Toronto has taken an unconventional approach that involves tumor-priming, high-dose radiation before the EPP surgery.
Researchers there reported a three-year survival rate of 58%, including an 84% survival rate for those with the epithelial mesothelioma subtype.
Conversely, most multidisciplinary treatment centers in the U.S. start with chemotherapy before aggressive surgery and end with radiation, if used at all.
“Future trials in operable mesothelioma should use P/D as the main surgical approach in order to achieve the goal of cytoreduction and to return patients to potential additional oncologic therapy,” the study concluded.