Study Overview
A 2023 study from Baylor College of Medicine by Ripley et al. offers important insight for patients and families facing a challenging diagnosis: mesothelioma that has spread to both the chest and the abdomen. Although mesothelioma is notoriously aggressive and often diagnosed late, the researchers found that certain patients may achieve long-term survival, particularly when surgeons use a lung-sparing approach.
Background: Mesothelioma Disease Characteristics
Mesothelioma typically develops decades after asbestos exposure. Once symptoms, such as shortness of breath, chest pain, or abdominal swelling, begin the disease can progress rapidly. Treatment options remain limited, and even modern chemotherapy and immunotherapy usually provide survival measured in months rather than years. Surgery can play a role for some patients, but in rare cases where mesothelioma involves both the chest cavity and the abdomen, doctors have historically had little guidance on whether aggressive surgical treatment could truly improve outcomes.
Study Design and Surgical Approaches
The researchers set out to study this question. Out of 440 mesothelioma patients evaluated over a seven-year period, 14 were healthy enough to undergo a two-stage operation: one surgery for the chest and one for the abdomen. In the chest, surgeons used two different procedures: Extended pleurectomy and decortication (ePD) aims to remove all visible cancer while preserving the lung, while extrapleural pneumonectomy (EPP) removes the tumor requiring removal of the entire lung on the affected side. Each patient in the study underwent abdominal surgery as well, usually combined with heated chemotherapy.
Key Findings and Survival Outcomes
Despite the small number of patients, the results revealed a pattern. Those who underwent the lung-sparing operation (ePD) lived longer than those who had their lung removed. Median survival for patients who had ePD was 58.2 months, nearly five years. For patients who received EPP, median survival was 13.5 months. Across the entire 14-patient group, regardless of procedure, one in five patients were still alive five years after both surgeries. While this rate is higher than typically seen in mesothelioma, the strongest outcomes were observed in the group whose lungs were preserved
Why Lung‑Sparing Surgery May Be Superior
The study offers clues about why lung-sparing surgery might lead to better outcomes. Researchers observed that patients living with only one lung after EPP struggled more during recovery from the second operation, particularly because of the intense fluid shifts and physiological stress associated with abdominal surgery and chemotherapy. Two patients in the EPP group died within 90 days of their abdominal operation, while no early deaths occurred among those who had ePD. These findings align with a broader shift already underway in mesothelioma treatment: a move away from EPP and toward lung-preserving approaches whenever possible
Implications for Treatment
Although this study involved only a small number of patients, the findings suggest that long-term survival may still be possible in carefully selected cases when mesothelioma has spread to both the chest and abdomen. The results also indicate that lung-sparing surgery (ePD) may offer an advantage over more extensive lung-removing procedures when surgeons pursue aggressive cytoreductive treatment for bicavitary disease
Practical Takeaways for Patients and Families
Taken together, the study highlights two practical takeaways for patients and families. First, treatment at a specialized center with deep experience in mesothelioma can be especially important for complex or advanced disease patterns. Second, the specific surgical approach matters. Preserving the lung, when medically appropriate, may improve recovery and offer a better chance at long-term survival
