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Lung-Sparing Surgery May Extend the Survival of Pleural Mesothelioma Patients

Posted in: Prognosis April 27, 2017 By Stan Gottfredson Read by 728 Users

A study published in the Annals of Thoracic Surgery in December 2016 suggests that lung-sparing surgery, which involves the removal of the pleura, can significantly increase the life expectancy of stage 3 and stage 4 pleural mesothelioma patients. Moreover, this surgical procedure also preserves elderly patients’ quality of life, as it does not entail the resection of the lung. In conjunction with photodynamic therapy and chemotherapy, lung-sparing surgery has resulted in a median survival of 3 years for the majority of the 73 mesothelioma sufferers who participated in the study, while 19 of them lived for over seven years following treatment.

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The author of the study is Dr. Joseph Friedberg, MD, Director of the Mesothelioma and Thoracic Oncology Treatment and Research Center at the University of Maryland School of Medicine in Baltimore. Between 2005 and 2013, he and his medical team performed lung-sparing surgeries on the 73 study participants, most of whom were struggling with stage 3 or stage 4 pleural mesothelioma. While traditional mesothelioma surgery entails the resection of the entire lung, as well as of the pericardium and diaphragm in certain cases, Dr. Friedberg’s surgical approach is less radical and apparently, more effective.

During lung-sparing surgery, only the pleura – the outer lining of the lung – is removed, along with all visible traces of cancer. Thereby, the organ remains intact. Nevertheless, the procedure is very demanding, taking between 6 and 14 hours to reach completion. “Although from a technical perspective, it is more challenging to save the lung than to sacrifice it, it does appear that this technique helps to not only extend life but to also preserve the quality of life”, Dr. Friedberg said.

As mesothelioma is often discovered when the disease is considerably advanced, most patients receive chemotherapy as a single treatment. Due to the severity of cancer, less than 20% of them are eligible for aggressive surgery. Thus, it is probably not surprising that the average survival for pleural mesothelioma ranges between 12 and 18 months. However, when patients undergo lung-sparing surgery, which is low-risk and does not put such a heavy strain on their condition as traditional surgery, survival doubles.

According to Dr. Friedberg’s research, the median survival for mesothelioma patients treated with a combination of lung-sparing surgery, photodynamic therapy, and chemotherapy was 35 months. Additionally, 19 patients experienced a survival of 7.3 years. “This is among the most virulent cancers known to man, and we have a long way to go, but it's encouraging to have achieved results we can report in years not months even for these patients with such advanced disease”, he said. It is worthy of note that most pleural mesothelioma patients who participated in the study conducted by Dr. Friedberg were suffering from the epithelial subtype of the disease.

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The beneficial effects of lung-sparing surgery on mesothelioma survival are also supported by a more recent study, which was published in the European Journal of Cardio-Thoracic Surgery this month. The purpose of the study was to observe how each of the three lung-sparing surgical approaches employed in the treatment of pleural mesothelioma affect survival:

  • standard pleurectomy/ decortication – removes the pleura and most of the tissues affected by cancer in the chest cavity
  • partial pleurectomy/ decortication – which also involves the removal of the pleura, but leaves more tissues unattended
  • extended pleurectomy/ decortication – during which the pleura, the pericardium, and the diaphragm, as well as other tissues, are removed

The cases of 314 mesothelioma patients who underwent lung-sparing surgery were analyzed by thoracic surgeons from eleven Italian institutions between 2011 and 2014. Similarly, the majority of participants were diagnosed with the epithelial subtype and 62% of them were suffering from stage 3 pleural mesothelioma. Extended P/D was performed on 162 patients, 115 participants underwent standard P/D, and the remaining 37 mesothelioma patients had partial P/D.

Researchers concluded that, while both standard and extended P/D can prolong the life expectancy of pleural mesothelioma patients to a great extent, partial P/D has no impact on survival. Whether the P/D is extended or not, it shows similarly good outcomes in terms of early results and survival rate. In contrast, a partial pleurectomy, which leaves gross tumor behind, has no impact on survival”, writes Dr. Giuseppe Marulli, the author of the study.

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