Choice of Surgical Treatment for Mesothelioma Remains Complex
Whether such trials will ever be performed is an open question. Despite the recent Mesothelioma and Radical Surgery (MARS) trial, which demonstrated the possibility of randomizing patients to surgical vs. nonsurgical treatment, there will likely never be a randomized clinical trial powered enough to completely solve the puzzle, according to Dr. Tom Treasure of the University College of London (Eur. J. Cardio-Thorac. Surg. 2010;37:509-10).
Efforts continue to develop surgical alternatives with less mortality and morbidity than those of the standard EPP and PD procedures. For example, Dr. M.D. Kluger and colleagues at Columbia University, New York, reported the phase I and II results of a recent clinical trial on a two-stage operative cytoreduction procedure coupled with intraperitoneal chemotherapy (Eur. J. Surg. Oncol. 2010; doi:10.1016/j.ejso.2010.07.001). They found that their protocol offered median survival comparable to that of one-stage protocols; rates of morbidity, mortality, visceral resections were relatively low and length of stay was relatively short despite the need for two operations.
Ultimately, surgery might be totally immaterial in some cases. In two recent papers, the type of surgery was not found to be predictive of survival. The poor prognosis of sarcomatoid MPM was independent of the extent of surgery, unlike other cell types (Ann. Thorac. Surg. 2010;89:907-11), and the combination of several immunohistochemical markers was found to be the only valid prognostic indicator of survival, including type of surgery (Eur. J. Cardio-Thorac. Surg. 2010;38:245-53).
None of the authors mentioned in this article had disclosures deemed relevant to their reported research.
Dr. Flores (left) transects the main pulmonary artery of a mesothelioma patient with the assistance of a thoracic fellow. (Photos Courtesy of Dr. Raja M. Flores)
In this photo, the tumor has been completely resected. It takes highly trained suregons to perform an en bloc resection of the lung, pleura, lining of the heart (pericardium), diaphragm, and tumor. The chest is free of all gross disease.
