According to a new research study, surgery for older malignant pleural mesothelioma (MPM) patients isn’t always riskier than it is for younger patients. The study also says that lymph node involvement and adjuvant chemotherapy are better predictors of mesothelioma surgery outcomes than age.
The large study consisted of 300 MPM patients who underwent extended pleurectomy decortication (EPD) over the 17-year period between 1999 and 2016. Patients were separated into two groups by age at operation—younger than 70 years (218 patients) or 70 years and older (82 patients).
According to the research team, “because of the increasing age of patients and differing comorbidity profile of patients referred to our center with mesothelioma for consideration of radical surgery, an intentional transition from routinely performing EPP to EPD occurred over this time period. During the transition period, the main indications for EPD over EPP were patient age, pulmonary function precluding a pneumonectomy and mediastinal lymph node positivity. One hundred and thirty-four patients underwent EPP during this same time period.”
The study found that "there was no intergroup difference in length of hospital stay or in in-hospital, 30-day or 90-day mortality.” What made a bigger difference, said the report “was whether or not a mesothelioma patient had chemotherapy either before or after their surgery. Regardless of age, patients whose mesothelioma cancer had spread to their lymph nodes had poorer outcomes.”
Led by Clinical Fellow and cardiothoracic surgeon Annabel Jane Sharkey, MD, the research team concluded that, “although age itself should not be a criteria for selection for radical surgery with EPD, we must ensure that we do not render our patients unfit for adjuvant chemotherapy and that we avoid the need for postoperative intensive care admission where possible. We must remain highly selective, while not excluding patients from undergoing EPD based solely on their advanced age.”
The study was published in the journal Interactive CardioVascular and Thoracic Surgery (ICVTS).
Although there is no cure for mesothelioma, treatments have come a very long way over the years, with “individualized” treatment becoming more common. So, if you have been diagnosed with mesothelioma, your doctor will discuss all of the treatment options available for your specific type of mesothelioma.
Sources
Sharkey, Annabel Jane, Rocco Bilancia, Sara Tenconi, Apostolos Nakas, and David A. Waller. "Extended Pleurectomy Decortication for Malignant Pleural Mesothelioma in the Elderly: The Need for an Inclusive Yet Selective Approach." Interactive CardioVascular and Thoracic Surgery 25.5 (2017): 696-702. Oxford Academic. Web. 6 Dec. 2017.
