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Two Surgical Options for Treating Mesothelioma

Mesothelioma is a fatal cancer caused by exposure to asbestos that is generally unresponsive to standard treatment options, even when used in combination.  Research into new modalities for treatment of malignant pleural mesothelioma is constantly being explored. 

One standard option has been surgery, with the goal of achieving a macroscopic complete resection, and then following with adjuvant therapies such as chemotherapy and/or radiation therapy.  Resection is the complete or partial removal of an organ (in mesothelioma this is usually the lung) without damaging surrounding or vital structures. 

Over the past decade, clinical trials have been investigating the efficacy of two different surgical options in treating mesothelioma:  extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D).  EPP is an extensive surgery that involves the removal of the entire lung, the lining of the heart (pericardium), and a portion of the diaphragm.  Patients must be in fairly good health condition to undergo such organ loss and survive. 

Pleurectomy/decortication (P/D) only involves the removal of the tumor and the lining of the lung (pleura), but not the complete removal of the lung.  This is a good surgical option for patients with advanced stages of mesothelioma or when complete removal is not recommended.  P/D also has the advantage of treating targeted sites and leaving behind more internal structures that reduce the risk of the cancer spreading to other parts of the body. 

It used to be thought that removal of a diseased lung would give the best chance of prolonging survival time, however is now generally agreed that preservation of the lung is optimal, especially in early stages of cancer.

Recent studies also support usage of the two different operation modalities depending on stage of disease.  P/D is generally recommended for early stage mesothelioma if complete removal is possible, otherwise EPP may have more advantages, especially as the disease progresses to stage III.  It is recommended to leave the lung in place if the cancer has reached stage IV.  Accurate staging is essential for deciding the best surgical intervention. 

Mesothelioma, like many cancers, is described by stages, with stage I being the small and localized and progressing to stage IV, where the tumors have grown and malignancy has spread throughout the body.  The earlier the stage, the better chance that treatments will be effective.

Recently, a thoracic surgeon, Jonathan Daniel, MD, joined the Cardiothoracic Surgery Unit at the University of Arizona.  He performed an extrapleural pneumonectomy on a 65 year old man who had been diagnosed with mesothelioma, with great success.  UA hopes that the addition of Daniel to the surgical team already in place will make the Arizona Cancer Center a premier facility in the Southwest for treating mesothelioma. 

For other clinical trials and mesothelioma oncologists and surgeons, please visit the National Cancer Institute website at:  www.cancer.gov/clinicaltrials