Malignant pleural mesothelioma (MPM) patients who undergo pleurectomy (P/D) surgery usually live better and longer lives than those who have extrapleural pneumonectomy (EPP) surgery, finds a study featured in the Annals of Translational Medicine.
The study, “The impact of surgical approach on quality-of-life for pleural malignant mesothelioma,” highlights the importance of quality-of-life measures in the treatment decision-making process when recommending surgery-based therapies for such an aggressive disease. In EPP, doctors remove all tissues affected by cancer, including the lungs if necessary, while in P/D, also known as lung-sparing surgery, only the pleura, or lining of the lungs, and cancer masses are removed.
Despite the many advances in tackling mesothelioma cells, MPM patients still face a poor prognosis, with an average 15 months to live following initial diagnosis, This is why finding ways to improve patients’ quality of life is a primary goal.
“Palliative care is offered to most patients, as many have an advanced stage of this disease, and commonly have numerous co-morbidities which prevent the usage of aggressive treatment,” the team wrote.
Currently, about 22 percent of MPM patients have surgery. Previous studies have shown that surgery is an independent predictor of extended survival for these patients. But which is the most efficient surgical approach, and which offers the best outcome? In analyzing such questions, doctors also must consider the impact such treatments have on a patient’s quality of life.
Researchers at New York’s Hofstra Northwell School of Medicine — in collaboration with colleagues at Mount Sinai’s Icahn School of Medicine at Mount Sinai — compared the impact of EPP and P/D on 523 patients with MPM, using quality-of-life data collected from previously published studies. They found that both strategies significantly hurt patients’ quality of life in the first six months after surgery, specifically regarding lung function parameters, physical symptoms,and physical and social functions.
Still, the team found that patients who undergo P/D surgery tend to have better quality-of-life outcomes, a finding that coincides with that of previous reports.
“This is not surprising given that increased morbidity has been associated with EPP more often than with P/D,” the team wrote, adding that those who undergo P/D tend to have more acute co-morbidities, so they may be less suitable candidates for EPP. “In conclusion, although this review generally finds that P/D has better QoL [quality-of-life] outcomes for MPM surgical patients, more comprehensive cohort studies are needed. MPM patients and surgeons could greatly benefit from this increased body of knowledge when engaging in surgical decision-making.”