There are different procedures to help those suffering from mesothelioma, including the extrapleural pneumonectomy and the combination of pleurectomy and decortication. Both procedures have their benefits and drawbacks, but doctors have not tested to see which procedure has a better outcome for patients. Both surgeries remove tumors from the patients’ bodies, but what is removed differs and can lead to different outcomes for patients.
When a doctor performs an extrapleural pneumonectomy, the patient goes under general anesthesia and the chest cavity is opened. The diseased lung, part of the lining of the heart, part of the diaphragm, and part of the parietal pleura are all removed during the procedure. This is a very complex and invasive procedure which means patients going through it have to be in relatively good health- they have to be in the early stages of mesothelioma and the cancer should not have spread to the lymph nodes prior to the surgery. This surgery is very beneficial and can help impact life expectancy of those suffering from mesothelioma, especially when combined with radiation and chemotherapy. It does have risks, which include internal bleeding, respiratory failure, pneumonia, infection, and blood clots. The cancer can also come back, leading patients to being in the same position as before they received the surgery.
When doctors perform a pleurectomy/decortication, they are performing two separate procedures. First the doctor performs the pleurectomy, where the chest is opened and the lining around the lungs is removed with other diseased tissue. The decortication is then performed where doctors remove any tumor masses that are visible on the lung and the other areas inside the chest. This combination can help symptoms, and has a high success rate of 90 percent of patients seeing reduced symptoms. There are complications that occur during the surgery leading to death, with 1 to 2 percent of patients dying during or after the procedure. Patients can also suffer from complications including a prolonged air leak. This surgery is less invasive than an extrapleural pneumonectomy, and the median survival for patients undergoing the procedure is 20 months.
Doctors studied the outcomes and life expectancies of patients who underwent extrapleural pneumonectomies and pleurectomies/decortications from 1990 to 2018. The researchers looked at the 30 day and 90 day mortalities of patients who underwent the procedures as well as the one, two, three, and five year survival rates and the median overall survival rates for patients. The researchers found that the 30-day mortality was much higher for the extrapleural pneumonectomy patients and the overall survival increased for the patients receiving a pleurectomy/decortication. The 90-day mortality and the one, two, three, five-year survivals were also very similar, leading to the conclusion that they are not affected by either. Complications were also high for the extrapleural pneumonectomy patients, with significantly higher amounts of patients suffering from atrial fibrillation, hemorrhage, empyema, bronchopleural fistula, and air leak. The researchers suggested that when possible, the pleurectomy and decortication procedure should be performed over an extrapleural pneumonectomy.
Dimitrius Magouliotis, “Extrapleural pneumonectomy versus pleurectomy/decortication in malignant pleural mesothelioma: an updated meta-analysis of survival endpoints” European Respiratory Journal (2019). [Link]
“Extrapleural Pneumonectomy” UCSF Department of Surgery [Link]
Tedi Vlahu and Wicki T. Vigneswaren, “Pleurectomy and decortication” Annals of Translational Medicine (June 2017). [Link]