A new study is asking the question, is it possible to remove a malignant mesothelioma tumor with pleurectomy-decortication (P/D) without risking the spread of new tumors?
P/D, the lung-sparing pleural mesothelioma surgery, has become the preferred approach in many cases where mesothelioma has not spread to the lung tissue.
Most studies have found that P/D has a lower complication rate, produces less pain, and allows for faster recovery than the more radical extrapleural pneumonectomy (EPP), in which surgeons remove a lung along with the diseased pleural membrane.
But as a group of Japanese researchers note in a new article in the journal Surgery Today, the current method of performing P/D also poses significant risks for mesothelioma patients. One of these is the possibility that the procedure itself can end up causing new mesothelioma tumors.
P/D Can Seed New Mesothelioma Tumors
“At the beginning of pleurectomy, a sharp pleural incision through the tumor is usually made to create the dissection plane between the visceral pleura and the lung parenchyma,” explains Fumihiro Tanaka, first author on the Surgery Today paper. “[This] may cause the spread of tumor cells into the operation field.”
In other words, the very incisions needed to remove a mesothelioma tumor via standard pleurectomy-decortication can inadvertently cause new mesothelioma tumors to grow, shortening the length of time a patient is likely to survive after surgery.
Minimizing the Spread of Mesothelioma after P/D
Dr. Tanaka is part of a team of surgeons at the University of Occupational and Environmental Health in Kitakyushu experimenting with a new approach to P/D surgery for mesothelioma aimed at minimizing tumor-seeding risk.
The team describes it as “a sophisticated surgical technique” that does not involve cutting into the pleura, the membrane where mesothelioma tumors grow.
They call the technique “non-incisional P/D” and say it allows a surgeon to remove the entire pleura and tumor at once, which researchers believe may improve postoperative mesothelioma survival.
Tumor Spread with Other Procedures
P/D is not the only mesothelioma treatment that can inadvertently cause new mesothelioma tumors. Other interventions such as the insertion of a needle or indwelling pleural catheter to drain excess lung fluid can have the same effect since they pierce the pleura.
By disturbing the DNA of cells along the insertion path, some studies have found that applying targeted radiation can reduce the possibility of seeding new mesothelioma tumors there.
Tanaka, F, et al, “Non-incisional pleurectomy-decortication for malignant pleural mesothelioma”, February 28, 2018, Surgery Today, Epub ahead of print