Pleurectomy

Mesothelioma surgery pleurectomy is used to remove the pleural layer that lines the chest wall, the area of the thoracic cavity between the lungs, the sac surrounding the heart, and the diaphragm. The second part of this procedure is called a decortication, which means to remove the outer covering of an organ. In this case the visceral pleura, or the part of the pleura that covers the lung, is removed.

Pleurectomy for Relief from Mesothelioma Symptoms

This type of mesothelioma surgery can be used for cytoreduction that is debulking the tumor. However, even though the tumor is made smaller, some residual tissue remains. That is why pleurectomy is not considered a curative procedure and it is used as part of a multimodality therapy, meaning the patient receives chemotherapy and/or radiation after the procedure.

In a study titled Is pleurectomy and decortication superior to palliative care in the treatment of malignant pleural mesothelioma? published online February 22, 2011 in Interactive CardioVascular and Thoracic Surgery, researchers looked for studies that helped them determine if pleurectomy is the better method for alleviating symptoms compared to other forms of treatment.

The studies they found that reported patient outcomes after use of radical pleurectomy/decortication showed a higher average survival than other supportive care and non-radical decortication. However, radical pleurectomy/decortication had a 30 percent complication rate, required a hospital stay of 12 days, and had an operative mortality rate of 9.1 percent. One-year survival rate was 65 percent.

The studies that examined the use of chemotherapy to relieve symptoms showed that the average survival rate was 14 months for those who received chemotherapy early as compared with 10 months for those patients that delayed treatment. Patients with early chemotherapy also had an average of 25 weeks before disease progression and a 66 percent one-year survival rate.

The evidence presented from their examination of these studies led the researchers to conclude:

P/D (pleurectomy/decortication) is a morbid operation that is associated with significant perioperative mortality (death occurring in the time between the surgery and release from the hospital) and complication rates. Although a number of retrospective studies have shown a small benefit in survival with P/D, the heavily documented similarity in patient outcomes between P/D and extrapleural pneumonectomy along with the results of the Mesothelioma and Radical Surgery trial, should induce the surgical community to consider the use of P/D only in patients with malignant mesothelioma enrolled in prospective trials.

Recurrence of Mesothelioma After Pleurectomy

In this type of mesothelioma surgery, disease typically returns in an area local to the original disease site. For that reason, pleurectomy is combined with other therapies to increase survival time.

In a study titled Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients, published March 2008 in the Journal of Cardiovascular and Thoracic Surgery, researchers conducted a multi-institutional study to find patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy or pleurectomy/decortication. They identified 538 men and 125 women who underwent either type of mesothelioma surgery between 1990 and 2006. The average age of the patients was 63 years old.

Three hundred and eighty-five patients underwent extrapleural pneumonectomy and 278 underwent pleurectomy/decortication. Twenty-seven of the extrapleural pneumonectomy patients died and 13 of the pleurectomy/decortication patients died.

Although patients who underwent pleurectomy/decortication had a better survival rate than those who underwent extrapleural pneumonectomy, there were a number of factors that influenced this including the stage of the cancer, the type of cells within the tumor, the gender of the patient and whether or not the patient received other forms of therapy after the mesothelioma surgery.

This evidence led the researchers to conclude that, “At present, the choice of resection (type of surgery) should be tailored to the extent of disease, patient comorbidities (other existing health conditions), and type of multimodality therapy planned.

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