Pleurectomy and Decortication (P/D) is a two-part surgical procedure that removes the pleural lining around the lungs (pleurectomy) and tumors along the surface area of the lung (decortication). To qualify for this surgery, mesothelioma patients must be in overall good health, and in the early stages of the disease. Since mesothelioma is an aggressive cancer that is typically diagnosed once it is in the advanced stages, P/D is not a common treatment for most patients.
When used in conjunction with chemotherapy, radiation and immunotherapy, successful P/D procedures can result in extended survival upwards of 20 months, which is significant for a cancer that has a life expectancy of approximately 12 months or less after initial diagnosis. In some cases, the quality of life for patients improves dramatically, yet there is concern that more often than not, P/D disrupts the health-related quality of life (HRQoL) in mesothelioma patients and that the procedure itself should be questioned.
A recent study published in the World Journal of Surgery used The European Organization for Research and Treatment of Cancer core Quality of Life Questionnaire-C30 tool (EORTC QLQ-C30) to establish a baseline HRQoL to be able to determine the effects of the P/D 1, 4-5, 7-8, and 10-11 months following surgery. There were 114 patients, averaging 70 years of age in this study and following the P/D procedure, performance status and pathological tumor volume results were compared to baseline scores.
Results showed that patients in good standing performance status, epithelioid histology, and small pathological tumor had less overall symptoms and seemed to be functioning well, but overall global health declined after the first month of surgery. Patients with non-epithelioid histology but that had a larger pathological tumor volume, showed symptomatic improvements in health and function. The study concluded that while there is some improvement in HRQoL, it is the most apparent with the first month of P/D.
P/D is not an easy operation and can be only done successfully by the most qualified surgeons. Recovery from P/D can take several weeks, and complications like blood loss and air leaks are not out of the ordinary. Scientists, researchers, and doctors are continually working on perfecting the technique, in hopes to make the procedure a standard treatment for those suffering from mesothelioma.
Vigneswaran WT, et. al., “Influence of Pleurectomy and Decortication in Health-Related Quality of Life Among Patients with Malignant Pleural Mesothelioma,” World Journal of Surgery (2017 September 25). [Link]