Pleurectomy/decortication can be completed safely in select patients with pleural mesothelioma with low postoperative mortality, according to findings from a study published in The Annals of Thoracic Surgery.
“Our findings show that pleurectomy/decortication can be done safely when patients are carefully selected and surgery is tailored to balance tumor removal with the patient’s ability to tolerate aggressive treatment,” said corresponding author Raja M. Flores, MD, Professor of Surgery at the Icahn School of Medicine at Mount Sinai, and Chair of Thoracic Surgery for the Mount Sinai Health System. “This study highlights that outcomes depend not only on whether surgery is performed, but how and in whom.”
Background and Study Methods
The prior phase III Mesothelioma and Radical Surgery 2 (MARS2) trial, had suggested that extended pleurectomy/decortication led to worse survival and more serious adverse events than chemotherapy alone for patients with resectable pleural mesothelioma.
This study, building on Dr. Flores’ prior work studying surgical outcomes in pleural mesothelioma, addresses careful surgical planning and patient selection to improve outcomes with surgery. Dr. Flores and his team looked at outcomes from between 2015 and 2021 at Mount Sinai, when the MARS2 trial was conducted, to highlight surgical outcomes for patients with pleural mesothelioma who underwent pleurectomy/decortication. Patients who underwent extrapleural pneumonectomy were excluded.
Key Findings
Seventy-one patients with pleural mesothelioma underwent pleurectomy/decortication at Mount Sinai in this time period. The 30-day mortality rate for this group was 0% and the 90-day mortality rate was 4.2%. Comparatively, the 90-day mortality rate in the MARS2 trial was 9%.
“This study reinforces that surgery should remain part of the conversation for mesothelioma treatment and can lead to long-term survivorship,” Dr. Flores said. “At experienced, high-volume centers, pleurectomy/decortication can be an effective component of multidisciplinary care.”
The researchers suggested that patients with the epithelioid subtype tend to respond better to surgery; 78.9% of the Mount Sinai group had epithelioid pleural mesothelioma. Only 2.8% of the group had sarcomatoid histology, as this subtype tends not to respond as well to surgery. Additionally, all patients received rigorous testing prior to surgery.
They also suggested that a patient-tailored approach that includes maximal cytoreduction as tolerable and the avoidance of seeding untouched peritoneal and pericardial spaces improves patient outcomes.
“These results offer hope and clarity for patients facing a difficult diagnosis,” he added. “Surgery is not for everyone, but for the right patients, it can be both safe and meaningful.”
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