From the blog

Pleurectomy and Decortication is the Best Option for Bicavity Surgery on Peritoneal Mesothelioma

Published: January 13, 2023

Patients with thoracic and abdominal mesothelioma can extend survival when they are given aggressive surgery. This news came from a study at Baylor College of Medicine in Houston. When patients are given bicavity cytoreductive surgery, they had a median survival of 58.2 months.  The results were published in December in the Journal of Thoracic and Cardiovascular Surgery. Mesothelioma is a hard-to-treat cancer that is mainly caused by asbestos exposure. It is rare for mesothelioma to be found in both the chest and abdomen, so having surgery in both cavities is almost unheard of.

There were 440 patients with mesothelioma who were evaluated at the Baylor College of Medicine from the years 2014 through 2021. Fourteen (3 percent) underwent chest and then abdominal surgeries. Eight of the 14 patients had pleurectomy and decortication (P/D) surgery and six had extrapleural pneumonectomy (EPP) surgery. During the abdominal part of the surgery, all 14 patients underwent standard peritonectomy and hyperthermic intraperitoneal chemotherapy. There were six patients who received chemotherapy between the operations and five received chemotherapy after every individual operation.

The median overall survival was 33.6 months and the five-year survival rate was 20 percent. The reason for the study was to find if pleurectomy and decortication surgery or extrapleural pneumonectomy surgery was more effective during a bicavity resection. The median overall survival for patients measured from the time of the patients’ second surgery was 13.5 months for extrapleural pneumonectomy patients and 58.2 months for the extended pleurectomy and decortication patients. The median progression free survival was 12.9 months compared with 26.3 months for EPP and 26.3 months for P/D.

The results of the study show why many mesothelioma specialty centers now choose pleurectomy and decortication surgery over the more aggressive extrapleural pneumonectomy. In earlier studies comparing the two surgeries, the surgeries had similar survival times, but P/D surgery had a quicker recovery and lower morbidity rate. All 14 patients survived the first surgery, so they all received the second surgery. Two of the patients in the extrapleural pneumonectomy group died within 90 days of the abdominal surgery. Based on the data from the 14 patients, the researchers would recommend performing only pleurectomy and decortication and not extrapleural pneumonectomy surgery in bicavity cytoreductive surgeries for the treatment of mesothelioma.

Taylor Rupley M.D. et al., “Pleurectomy and Decortication is Associated with Better Survival for Bicavitary Cytoreductive Surgery for Mesothelioma Compared to Extrapleural Pneumonectomy” (December 14, 2022). [Link]
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