On the rare instance that mesothelioma is diagnosed in the early stages of the disease, patients have the option for surgery. There are several surgical procedures used to treat mesothelioma. Some mesothelioma surgeries aim to provide a curative effect, while others are performed for palliative purposes. Pleurectomy/decortication (P/D) and extra pleural pneumonectomy (EPP) are two or many procedures for mesothelioma patients that can be successful given the right circumstances.
Pleurectomy /decortication (P/D)
This two- part procedure removes all of the outer membrane of the lung (pleural lining) and then removes any visible tumors. The lung itself is left as is, but in some cases the surgeon may remove other lining located on the chest wall, the heart sac, or even the diaphragm. Ninety percent of patients who have the procedure do experience reduced symptoms, but complications like blood loss or an air leak can be common, occurring in 1 in 10 people. The average survival after surgery may be close to two years. P/D is less invasive than EPP.
Extra pleural pneumonectomy (EPP)
In addition to the pneumonectomy (the surgical removal of the lung), an extra pleural pneumonectomy also includes the removal of the pleura, diaphragm, and pericardium (mesothelial lining of the heart). When this approach is used, it allows for the maximum removal of tumor growth, especially when the cancer is confined to the chest cavity. Removing the lung in its entirety is risky, as the other remaining lung needs to be strong enough to be able to support the function of two organs. This is an aggressive surgery that many consider to be a bit outdated when compared to P/D, which focuses on saving the lung. However, in successful cases the average survival can be upwards of 38 months.
Each surgery has its own set of success and mortality rates, complications, and survival time. To find out which surgery is truly the more effective procedure, researchers from the Hofstra Northwell School of Medicine and the Ichan School of Medicine at Mount Sinai studied the quality of life of mesothelioma patients after they received either P/D or EPP treatment. This study, published in BMC Cancer, focused on which procedure had better survival rates, less complications, and a better quality of life.
To measure this, data was collected from 14 datasets (17 articles), which included 102 EPP and 432 P/D. These studies were cohort or randomized control trials that reported on the quality of life after surgery. Lung function was measured 6 months after surgery. Researchers found that physical function, social function and global health were better for those who had received a P/D, but admitted that that quality of the evidence provided was low, and data limited. Overall, the study suggests that P/D could be the better, more successful option and that the quality of life after surgery should continue to be a factor in deciding what procedure is best to consider.
Surgery continues to be one of the best treatment options for those suffering from mesothelioma; however, it is often not viable. Most patients diagnosed with this aggressive disease receive their diagnoses in the later stages, and are too weak to withstand surgery. Despite continual research for new diagnostic techniques, there are little approved methods for early detection. Chemotherapy remains the first line treatment.
Schwartz RM et. al., Systematic Review Of Quality Of Life Following Pleurectomy Decortication And Extrapleural Pneumonectomy For Malignant Pleural Mesothelioma,” BMC Cancer (November 2018). [Link]