Clapper, Patti, Schweizer and Mason

A recent study from the University College London in the United Kingdom concludes that although surgery indicates some survival benefit for mesothelioma patients, performing any surgical procedures should be weighed against risk of morbidity.  Although methods have greatly improved since the first surgery, risk still exists and should be taken into consideration by the clinical healthcare team.

Mesothelioma is primarily linked with exposure to asbestos, with a latency period of anywhere from ten to fifty years from time of first exposure to development of symptoms.  Due to this long lag time, patients diagnosed with mesothelioma are most often over the age of 70, and the majority are men. Risk of mesothelioma is much higher for those whose occupations involved the use of asbestos or asbestos containing materials.

Surgery, when possible, is one of the standard forms of treatment for mesothelioma.  There are two main types of surgery performed:  pleurectomy/decortication(P/D) and extrapleural pneumonectomy (EPP).  The first operations for mesothelioma were not until the 1970s, and although some patients had success, the high mortality rates created too high a risk for many to choose this as a treatment option.  In the 1980s, advances had been made that reduced morbidity associated with surgical resections, and surgery became a standard frontline treatment when possible.

Not all mesotheliomas are operable.  Factors such as the individual characteristics of the tumor, location, size, stage, bulk, etc. determine if and which type of surgery is best.  EPP is usually performed with more advanced, locally invasive, and bulky tumors as long as the patients overall health indicates success.  P/D is usually performed for patients with less advanced size and metastases, where lungs and fissures are not yet affected.

An important factor to note is that with pleural mesothelioma, surgery can never remove the entire tumor.  The irregular anatomy of the pleura and thoracic cavity make it impossible to remove all of the cancer, therefore adjuvant therapy is always recommended for highest survival rates and to prevent recurrence.  This strategy of combining surgery with chemotherapy, radiation or an alternative therapy is called multimodality treatment.

The London study reviewed data of patients diagnosed with malignant pleural mesothelioma, the most common type which affects the thin membrane surrounding the lung.  Each of the patients had undergone some type of surgical resection and those that survived the longest had also chosen some form of adjuvant therapy.  The most optimistic survival advantage for undergoing surgery was no more than 9 months.  Longest survival times were for those that had surgery as well as multimodality treatment.

Although risk of morbidity continues and should be taken into consideration when choosing a treatment strategy, research does indicate not only increased survival times but also palliative relief that results in sustained and improved quality of life.  Consult with your medical team to determine which surgery, if any, is best for your particular case and also find a surgeon who specializes in this particular type of pleural resection.