Surgical techniques for those suffering from mesothelioma depend on how far the cancer has spread and if the patient is healthy enough to withstand such an invasive procedure. In many cases, the cancer has already spread too far and quickly, so surgery is not an option. For those able to treat their cancer with surgery, there are a several techniques that aim to provide curative effects. A recent study published in the Seminars in Thoracic and Cardiovascular Surgery investigated two common surgical techniques for mesothelioma – Pleurectomy/Decortication (P/D) and Extrapleural Pneumonectomy (EPP) – and found drastic differences between overall survival between the two.
Pleurectomy/Decortication and Extrapleural Pneumonectomy
Used in cases of malignant pleural mesothelioma, a pleurectomy involves the removal of part of the pleura, which is the initial infection point for the disease. Decortication is the surgical removal of all or part of the membrane and/or outer layer of an organ. In the case of a lung, this would indicate the removal of the visceral pleura. This means that P/D is a type of surgery that removes the lining of the lung and all visible tumors in the chest cavity. P/D spares removing the lung so it often has less risks and complications. However, the cancer may not be able to be removed in its entirety.
Surgery to remove an infected lung is known as a pneumonectomy, but to remove the lung and the surrounding pleura, diaphragm, and pericardium, is called EPP. EPP is much more invasive, and recovery time is longer. There are typically more complications that arise from EPP, but if all the cancer is completely removed, researchers theorized this would prolong survival. However, results from this latest study have shown that is not necessarily the case.
Between April 2004 and July 2016, 152 mesothelioma patients underwent treatment at the Hyogo College of Medicine in Japan. Of those 152 patients, 117 received surgery as part of their treatment. All but three patients had received chemotherapy prior and over 90 percent of the patients had epithelial cell mesothelioma. Patients were then gathered into three groups. Group 1 received traditional EPP, Group 2, a less invasive form of EPP, and Group 3, P/D. The overall average survival between groups is as follows:
- Group 1, EPP = 18.5 months
- Group 2, less invasive EPP = 41.9 months
- Group 3, P/D = 43.4 months
The study concluded that P/D is the better option in prolonging survival, and also has fewer complications, risks, and less recovery time that EPP. It is less invasive than EPP, which is why there are less surgical risks associated. It’s recommended that patients who are undergoing surgery for pleural mesothelioma receive the less aggressive lung-sparing surgical procedure.
Hasegawa, S. et.al., “Surgical Risks and Survival Associated with Less Invasive Surgery for Malignant Pleural Mesothelioma,” Seminars in Thoracic and Cardiovascular Surgery (January 2019). [Link]