A work group commissioned by the European Association for Cardio-Thoracic Surgery says enough evidence now exists to advise mesothelioma patients against extrapleural pneumonectomy (EPP).
Surviving Mesothelioma reports Dr. Giuseppe Cardillo of Carlo Forlanini Hospital in Rome and Dr. Tom Treasure with University College London wrote an editorial in the Annals of Surgery stating their conclusions on EPP earlier this month. Mesothelioma, associated with exposure to asbestos fibers, can affect the lining of the lungs, heart or abdomen, and due to a long latency period, mesothelioma is often hard to detect until it has progressed to its later stages, making treatment difficult. EPP removes one lung, the pleural membrane around the lung, all or part of the diaphragm, the pericardial membrane around the heart and other at-risk tissues. The work group claims the treatment is “clinically ineffective,” and has a high complication risk, according to the news source.
Because EPP has been said to increase patient life expectancies, the group notes only the healthiest patients are candidates for the surgery, and therefore, the results are skewed toward longer survival times. Instead, they point to a 2010 study of 945 patients that determined no survival difference between those who received EPP and those had an alternative surgery; the average survival time was 17 to 18 months regardless of treatment. A 2008 study found EPP led to worse patient outcomes even when an alternative surgery was used only on the sicker patients. Pleurectomy with decortication (PD) is an alternative that involves removal of many of the same tissues but leaves the lungs intact.
“The accumulated evidence points away from EPP as clinically effective and, if taken in its totality, the published evidence now allows those advising patients to give informed counsel,” they conclude.