Mesothelioma surgery that spares a patient’s lungs and diaphragm leads to better overall survival rates than surgery that removes part of the lungs and diaphragm, according to Italian surgeons.
The University of Pisa team’s study, “Is less also better? A single-institution experience on treatment of early stage Malignant Pleural Mesothelioma,” appeared in the European Journal of Surgical Oncology.
Those with malignant pleural mesothelioma (MPM) have a very low survival rate.
Doctors often use multimodal therapy to treat the disease, but it can lead to severe impairment of lung function, complications, and death. Importantly, the only mesothelioma treatment whose effectiveness has been validated in a randomized clinical trial is chemotherapy.
There are five stages of mesothelioma, and surgery can be used in each. But research on which surgical approaches are the best has been inconclusive because the results have varied so much from study to study.
The Pisa surgeons decided to compare the results of the tissue-sparing surgery they used in early-stage mesothelioma from 2005 to 2014 with the results of more invasive surgery that they found in scientific articles.
Alfredo Mussi, MD, led the research team. He is the chair of the Division of Thoracic Surgery in the university’s Department of Surgical, Medical, Molecular, and Critical Area Pathology.
The more invasive approach surgeons use with mesothelioma is called open pleurectomy. It involves the removal of the lung membrane, or pleura, and the partial removal of the diaphragm. The approach the Pisa doctors used was sparing the diaphragm and the pericardium — the membrane enclosing the heart — and giving the patient hyperthermic intrathoracic chemotherapy.
They operated on 26 patients in the 10 years — 23 male and three female. Twenty-three patients had epithelioid mesothelioma, the form of the disease most responsive to treatment.
Twelve patients had Stage I mesothelioma, which meant that the cancer was confined to one pleura, or membrane, on one side of the chest. The other 14 patients had Stage II mesothelioma. That meant the cancer was in both layers of the pleura on one side of the body, had formed a tumor mass, or was spreading to the lung or diaphragm.
Records indicated that the patients’ median overall survival rate was 35.6 months. The rate for Stage I patients was 46 months, and Stage II patients 23 months. The patients’ disease-free survival rate was 18 months. Stage I patients had the same survival rate, and Stage II patients a rate of 16 months.
The doctors said their Stage I patients’ results were better than those reported in scientific journals, and their Stage II patients’ results were similar to those seen in the journals.
A less-invasive approach “for the treatment of pleural mesothelioma in early stages allows promising long term outcomes with a complete sparing of pulmonary and diaphragmatic functionm” the doctors concluded. But they said larger studies are needed to confirm their results.