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Pleurectomy/Decortication as Treatment for Mesothelioma

Doctors are excited over the results of a relatively new combined surgical procedure for malignant pleural mesothelioma. Malignant pleural mesothelioma is an asbestos disease that causes cancerous tumors to grow in the mesothelial lining surrounding the lungs called the pleura or pleural sac. This form of asbestos cancer is one of the most aggressive and deadly, with very few mesothelioma treatment options available.  However, a relatively new combination of surgical procedures has been gaining acceptance and has even replaced older, outmoded forms of surgery as a top pick for treating mesothelioma. This form of treatment is called pleurectomy/decortication(P/D).

When trying to understand pleurectomy/decortication, it’s helpful understand a little of the anatomy involved. The pleural sac surrounds the lungs. It is composed of two separate membranes: the visceral pleura and the parietal pleura. In between the two, a lubricating fluid allows the lungs to move freely within the chest cavity during normal respiration without causing friction. When a patient suffers from pleura mesothelioma, cancerous tumors grow within these membranes. Not only do the bulk of the tumors decrease the room available for the lungs to expand and contract, but the tumors can cause increased pleural fluid build-up. This fluid can solidify making breathing a difficult, if not impossible, task.

Prior to recommending pleurectomy/decortication, most mesothelioma surgeons recommended a procedure called extrapleural pnuemonectomy (EPP), which required completely removing a lung and portions of the diaphragm. However, pleurectomy/decortication is a much less invasive procedure and can, in some cases, be accomplished through thoracoscopic surgery.

What is Pleurectomy/Decortication?

During pleurectomy/decortication surgery, mesothelioma surgeons remove the parietal pleura and perform a decortication of the lung. During decortication all fibrous tissue is removed from the visceral pleura and the excess fluid is drained from the pleural space. While doctors may choose to only resect part of the visceral pleura, called a partial resection, research has shown that mesothelioma patients who undergo a full resection have a much better post-surgical prognosis.

In addition, once the surgeon is able to open the chest cavity and see the full extent of the mesothelioma proliferation, they may choose to remove parts of the diaphragm and possibly portions of the pericardium, the membrane that encases the heart, to ensure that as much of the cancerous tissue is removed as possible.

The goal of P/D surgery is to remove most, if not all, of the tissue affected by the mesothelioma while keeping both lungs intact.

Research Points to P/D as Better Option for Radical Surgery

While not all mesothelioma patients choose to undergo such radical surgery, numerous post-surgical studies have found that pleurectomy/decortication is a better option for most when compared to other available procedures. Not only does it leave the lungs intact –improving post-surgical quality of life – but the risks associated with the surgery are fewer.

Indeed, P/D has been shown to have little or no increase on immediate death rates compared to more invasive surgeries such as extrapleural pneumonectomy (EPP), which some studies show may carry a higher risk of post-surgical death for months after the surgery.  Also, the instances of serious side effects and morbidity, such as post-surgical infections and other complications, are significantly  lower with P/D surgery than other options.

One retrospective study found that the extended life span of P/D patients versus EPP patients, when combined with another modality of treatment such as aggressive chemo, was quite dramatic. Up to 61% of P/D patients who also underwent a certain type of chemo lived past the two-year benchmark. That’s compared to just 18% of EPP patients. Indeed, that difference in life span only increases as patients are measured further from the date of surgery.

At the five-year benchmark, 30% of the P/D patients in the study were still alive compared to just 9% of their EPP counterparts.

This drastic difference in prognosis has led some mesothelioma specialists to passionately advocate pleurectomy/decortication as the recommended procedure for mesothelioma patients opting for radical surgery.  Almost all mesothelioma doctors, however, agree that the type of surgery is patient specific and recognize that those who suffer from drastically advanced mesothelioma may fair better, or at least live longer, undergoing EPP versus P/D.

As P/D gains popularity, the procedure will become more commonplace in cancer centers around the world and, statistics predict, the rates of adverse effects from the surgery will continue to decrease.  If you or a loved one has been diagnosed with mesothelioma, ask your physician for the nearest mesothelioma treatment center that has a surgeon who specializes in treating this type of cancer.