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Different Levels of Pleurectomy and Decortication Surgery can Save Mesothelioma Patients’ Lives

Published: February 4, 2022

Italian researchers believe that lung sparing surgery can improve survival in mesothelioma patients, even when surgeries are more conservative. Pleurectomy and decortication is the surgery that spares the lungs. It is less comprehensive than the surgery that removes the lungs, which also makes it less dangerous to patients. Doctors at the Venice-Mestre hospital have found that when pleurectomy and decortication surgery is done early enough and combined with the proper treatment, the surgery can save lives. Their report included data from 155 patients who were observed and followed for a median time of 1.5 years.

The other major surgery for mesothelioma is an extrapleural pneumonectomy. This surgery removes mesothelioma tumors, membranes on the chest, and a lung. This surgery is much more radical and comes with the possibility of complications and death. Despite the dangers, there are studies that show that there is an increased chance of survival for patients who receive the surgery. Pleurectomy and decortication surgery leaves the lungs in the body, but there are different levels of the surgery. The surgeons remove the pleura and then scrape as much cancer as possible off of the lungs. Doctors can then go further and remove the diaphragm or at least part of it and the mesothelial tissue surrounding the heart. Either way, doctors try to get the most amount of cancer out of the body, which could possibly help prevent the mesothelioma from coming back. Some doctors prefer using pneumonectomies while some prefer sparing the lungs since there are less complications.

There were 155 patients who were monitored that received the extrapleural pneumonectomy surgery. All the patients had epithelioid mesothelioma and either had stage 1, 2, or 3 cancer. They also had to be under 80 years old and in good general health besides the cancer. Sixty-five percent of the patients had chemotherapy before having surgery. The other 34 percent had chemotherapy after surgery. Sixty-eight percent of patients had normal Pleurectomy decortication surgery while 56 percent had extended surgery.

The researchers found that either surgery type is valid if done early enough. They both lead to longer survival when done at the right time. It was also found that patients who received surgery before the cancer spread to the lymph nodes lived longer compared to those whose cancer spread. Leaving the pericardium and diaphragm in the body also leads to a longer survival. It did not matter which type of pleurectomy and decortication surgery patients received because the recurrence for both was the same and patients who lived 12 months without the cancer recurring typically had a long term survival.

Cristiano Breda et al., “Long-term outcomes after lung-sparing surgery for epithelial mesothelioma” Journal of Thoracic Disease (November 2021). [Link]
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