Surgeon Says Standardization Needed for Mesothelioma Procedures, According to Surviving Mesothelioma

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A top mesothelioma surgeon says not using standard definitions for the various types of mesothelioma surgeries will make it impossible to settle the ongoing dispute over which operation is most effective.

There is...a degree of ambiguity about the extent of the procedure described in many published reports of P/D."

In an article detailed on Surviving Mesothelioma, Dr. David Rice of M.D. Anderson Cancer Center points out that the primary types of mesothelioma surgeries currently mean different things to different surgeons. Although the steps of extrapleural pneumonectomy (EPP), the most radical mesothelioma surgery which involves removal of a lung, have been standardized, the same is not true for the lung-sparing procedures, pleurectomy/decortication (P/D) and extended pleurectomy/decortication (EPD).

“There is, therefore, a degree of ambiguity about the extent of the procedure described in many published reports of P/D, unless the authors have taken the time to specifically outline their definition of the procedure and the therapeutic intent,” observes Dr. Rice in an article in the Annals of Cardiothoracic Surgery. This ambiguity may be adding fuel to the fire in the controversy over the best mesothelioma approach.

Mesothelioma is an asbestos-linked cancer that starts on the pleura, the lining around the lungs, and can quickly spread to other parts of the body. There is worldwide disagreement between mesothelioma experts over the value of removing the most vulnerable lung during mesothelioma surgery, as opposed to leaving it in place. EPP advocates cite various studies showing that the more radical approach offers a survival benefit, despite the higher risk of complications and even death. Advocates of the more conservative lung-sparing approaches say these procedures can significantly improve mesothelioma symptoms without the pain and risk of EPP.

In response to a 2011 survey of surgeons who agreed that standardization was need, the International Association for the Study of Lung Cancer (IASLC) came up with the following definitions:

  •     EPP – Resection of the inner and outer pleura, the diseased lung, and the pericardium and/or diaphragm, depending on the extent of the tumor
  •     EPD – Resection of the inner and outer pleura, and/or all or part of the diaphragm or pericardium
  •     P/D – Resection of the inner and outer pleura
  •     Partial pleurectomy – Resection of portions of the inner and/or outer pleura with the primary goal of symptom relief

Dr. Rice says adhering to these definitions, especially in research studies, will make it easier to fairly compare the different surgical approaches and, ultimately, improve the prognosis for patients with malignant pleural mesothelioma. His original article was published in the Annals of Cardiothoracic Surgery. (Rice, David, “Standardizing surgical treatment in malignant pleural mesothelioma”, November 2012, “Annals of Cardiothoracic Surgery, pp. 497-501, http://www.annalscts.com/article/view/1054/1616‎)

For nearly ten years, Surviving Mesothelioma has brought readers the most important and ground-breaking news on the causes, diagnosis and treatment of mesothelioma. All Surviving Mesothelioma news is gathered and reported directly from the peer-reviewed medical literature. Written for patients and their loved ones, Surviving Mesothelioma news helps families make more informed decisions.

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Michael Ellis
Cancer Monthy
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