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