P/D for Mesothelioma: Are the Studies Accurate? | Surviving Mesothelioma

P/D for Mesothelioma: Are the Studies Accurate?

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A new analysis of pleurectomy/decortication suggests that the most radical form of the surgery produces the best results for mesothelioma patients, but also carries the greatest risk. Pleurectomy/decortication or P/D involves the removal of the pleural lining where malignant mesothelioma grows. Removing all or part of the lining frees up the lungs to expand again, relieving life-limited mesothelioma symptoms such as shortness of breath. 

But, as the Australian researchers found in their mesothelioma analysis, the varying degrees of P/D can make it difficult to accurately compare the method to the more extensive lung-removing surgery or even to get an accurate picture of P/D outcomes. Extended or ‘radical’ P/D involves removing the entire pleural lining, while partial P/D involves removing only part of it. 

The new analysis looked at 34 P/D studies involving 1,916 mesothelioma patients. The studies were all conducted between 1985 and 2012. Twelve of them involved ‘extended P/D’, 8 of them did not distinguish which P/D method was used, and 14 studies focused on ‘partial P/D’. Mortality rates after the surgery ranged from 0% to 11% and the complication rates ranged from 13% to 43%. The median overall survival of mesothelioma patients after P/D was 7.1 to 31.7 months. 

Although the differences in P/D techniques among the different mesothelioma studies made it challenging to draw accurate conclusions, the authors did find a trend toward more complications and longer hospital stays among patients who had ‘extended P/D’. At the same time, they found that “overall and disease-free survival appeared to favor ‘extended P/D’ compared to less aggressive techniques”. They recommend that future studies on P/D adhere to one definition of the surgery, to get a more accurate picture of its success.

Mesothelioma experts around the world remain divided over which method is best for mesothelioma patients – lung-removing extrapleural pneumonectomy (EPP) or lung-sparing P/D. EPP is extensive and carries a high risk of complications and death. However, some studies suggest that its survival rates are better than P/D. Standardizing what is meant by ‘P/D’ for study purposes could help scientists in their efforts to compare the two surgical approaches in the future. 

Sources:

Cao, C, et al, “Systematic review of pleurectomy in the treatment of malignant pleural mesothelioma:, June 12, 2013, Lung Cancer, Epub ahead of print.

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