Pleurectomy Decortication vs EPP: Better Quality of Life, Little Difference In Survival For Mesothelioma Patients

There is an ongoing debate among mesothelioma physicians of the best surgical approach for pleural mesothelioma patients: the pleurectomy decortication (P/D) or the extrapleural pneumonectomy (EPP). In a recent study, researchers using post-surgical quality of life as a measure determined P/D is better for mesothelioma patients. However, another study showed little difference in survival.

Researchers from Hofstra Northwell School of Medicine and the Icahn School of Medicine at Mount Sinai reviewed the records of nearly 400 pleural mesothelioma patients who had undergone either P/D or EPP surgery. The team paid special attention to the patients’ symptoms, lung function parameters, and physical and social functioning six months post-surgery. Although both sets of patients had “compromised” functioning,” P/D patients fared better than EPP patients across QoL [quality of life] measures.”

The main goal of mesothelioma surgery is to achieve a macroscopically-complete resection, which refers to the removal of all visible tumor cells. However, mesothelioma often has a complex growth pattern making complete surgical removal very difficult. The follow-up treatment of radiation and chemotherapy is used to kill the remaining cells, or to prevent further growth of the cancer.

P/D, often referred to as a “lung-sparing surgery,”  is an invasive surgery for pleural mesothelioma patients that removes the lining of the lung and part of the diaphragm, but spares the lung.

The alternative to P/D for pleural mesothelioma patients is EPP, a more radical procedure that involves removal of a lung, the diseased lining of the chest cavity and heart, and a portion of the diaphragm.

The researchers concluded in the QoL study, “Quality of life is generally better for patients undergoing P/D compared to EPP, for an extended period following surgery… QoL outcomes should be strongly considered when recommending type of surgery for patients with this disease.”

In a second study published in the Journal of Oncology, researchers comparing survival for mesothelioma patients undergoing one of the two surgeries found no differences between the two surgeries in 30-day readmission or mortality. Although far more patients underwent P/D (1,036) than EPP (271), the team found that median overall survival in the EPP and P/D groups was 19 months versus 16 months. The researchers found no differences after propensity-matching.

Working with an oncologist in a mesothelioma treatment center offers mesothelioma patients the most up-to-date care available. Medical professionals who specialize in the treatment of mesothelioma patients are more in tune with new research and often take a collaborative and multi-modal treatment approach. Determining your treatment plan, however, should be a collaborative decision between the patient and doctor.

Sources:

• Hofstra Northwell School of Medicine and the Icahn School of Medicine at Mount Sinai
  http://atm.amegroups.com/article/view/13976/html
• Journal of Oncology
  http://www.jto.org/article/S1556-0864(17)30687-1/pdf