Do Surgeons Rate?

Even with decent data, many patients will still base their treatment decisions on intangibles, such as the doctor's bedside manner, the doctor's enthusiasm, location of the hospital, the hospital's reputation, and scuttlebutt found on Internet chat rooms. "Harry saw Dr. X and he's been alive now going on 5 years," may be more convincing to a patient than a stack of peer-reviewed randomized clinical trials.

Consumer Reports hasn't yet rated mesothelioma surgeons, but getting specific information about surgeons is crucial to choosing the best lifeboat. We faxed, emailed, and made follow-up phone calls to the top mesothelioma surgeons in the country, and we applaud those who participated in our survey. We laud doctors who disclose that surgery alone doesn't result in a cure, who freely share their data with their patients and the medical community, and who advocate for more research to buy mesothelioma patients more time

The nonresponse rates of the doctors to whom we sent surveys also illustrate the problem: if I can't get complete surgical data leveraging my career and contacts in mesothelioma law and science, how much harder is it for patients to self-educate?

We also used Medline to research the published results of the surgeons we surveyed who did not respond, and contacted a total of about fifteen mesothelioma surgeons. In Chart J1, "Surgeons who responded to Worthington survey," we list as much baseline data as we could get from thoracic surgeons who treat meso. We also included a column to find out which surgeons testify for their mesothelioma clients. A patient should know whether their doctor feels comfortable sharing with a jury their expertise in treating the disease and assessing the damages. In Chart - "Surgeons who did not respond to survey, but for whom some published data was available," we list doctors for whom we found some data on the Internet.

Surgeons who responded to Worthington survey

#
MM
Cnslt
Per/
Yr 		#
MM
Trted
Per
/Yr 		Est.# of
MM
Trted Car. 		=EPP P/D TP Surg.
Mort. 		Pre-
Op
Chemo 		Post-
Op
Chemo
/Rad 		Median
Surv.
Mos. 		Est.#
of
Depos
For
MM
2006
Robert
Cameron
(a) 		75 40

300

N

Y

Y

<1%

N

Y

18-36

6
Raja
Flores
(b) 		60

50

450

Y

Y

Y

1%

Not
always

Not
always

20

0
David
Harpole
(c) 		40-
50

40-
50

250+

Y

Y

Y

5%

Y

Pref.

20-22>
tri-
modal-ity 		1*
Harvey
Pass
(d) 		60

35-
45

400-500

150

 100

N 5% [EPP] 1% [PD] 2%
[all
MM]		 Y

Y

Stage dep 3

David
Rice
(e) 		80

30

180

Y

Y

N

3%

+/-

Y

Stage dep 3

Larry
Robinson (f)		 ~20 ~10 ~120 Y Rare Y <3% N Y Stage dep 2
Eric
Vallieres
(g) 		20

15 ~150 Y Y
Rare

Y

4%

Y

Rad. ~24

~5

The following surgeons did not respond to the survey nor was any published EPP/PD median survival research available on PubMed: Robert Caccavale, Joseph Friedberg, Daniel M. Labow, David P. Mason, Daniel L. Miller, Valerie Rusch, , Stephen C. Yang

Footnotes

a

Surgical Criteria: Disease limited to predominantly epithelioid histology in one hemithorax, adequate cardiac and pulmonary function

Surgeon's comments: "Each patient must be looked at individually. Surgical procedure should be tailored to the patients' functional status, extent of disease and type of meso. And must take into consideration patients' goals."

b

Surgical Criteria: Disease limited to predominantly epithelioid histology in one hemithorax, adequate cardiac and pulmonary function

Surgeon's comments: "Each patient must be looked at individually. Surgical procedure should be tailored to the patients' functional status, extent of disease and type of meso. And must take into consideration patients' goals."

c

Surgical criteria: [for EPP] epithelial or mixed histology verified by Roggli; adequate PFT's with differential ventilation-perfusion scan; normal dobutamine echo without evidence of pericardial involvement; mesothelioma protocol CT with 3-D reconstruction; PET without distant disease; no significant co-morbidity. [for PD] verified pathology, can include sarcomatoid; either significant co-morbidity or T4 disease.

Surgeon's comments: "Duke University sees most of the mesothelioma cases in the southeastern U.S."

d

Surgical criteria: Stage I-II, (occasionally Stage III node neg.), physiologically fit for surgery

e

Surgical criteria: non-sarcomatoid; confined to ipsalateral hemithorax; not N3; no trans-diaphragmatic involvement; estimated post-pneumonectomy FEV ≥ 1.0 1/min/sec; cardiac status healthy. Website: www.mdanderson.org/diseases/mesothelioma.

Surgeon's comments: "The above comments apply to extra-pleural pneumonectomy, not pleurectomy. Comparing survival rates for this disease is MEANINGLESS unless one compares stage-specific survival."

f

Surgical criteria: Predominantly epithelial histology with disease limited to the hemithorax and no obvious nodal involvement. Website: www.mychestsurgeon.com.

Surgeon's comments: "With maintenance interferon therapy median survival exceeds 3 years."

g

Surgical criteria: Fit, early stage, good cardiorespiratory reserves

1

Review of 328 patients who underwent EPP, "Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies," J Thorac Cardiovasc Surg. 2004 Jul;128(1):138-46

2

Review of tri-modal EPP in 183 patients, "Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients," J Thorac Cardiovasc Surg. 1999 Jan;117(1):54-63; discussion 63-5. Patients with epithelial, margin-negative, extrapleural node-negative resection had extended survival.

*** POSTED ON FEBRUARY 7, 2008 ***