When surgery is indicated for mesothelioma, doctors typically turn to one of two procedures: extrapleural pneumonectomy or pleurectomy/decortication (P/D). Of the two, extrapleural pneumonectomy is the most extensive and risky, involving removal of a lung, the lining of the lung, and parts of the diaphragm. Though somewhat controversial, this mesothelioma surgery is well-defined in most centers. In contrast, a new study finds that surgeons vary widely in their definition of pleurectomy/decortication.
To get a better understanding of what mesothelioma surgeons mean when referring to P/D, members of the International Association for the Study of Lung Cancer and the International Mesothelioma Interest Group conducted a web-based survey of 62 surgeons from 39 medical centers who had performed at least one mesothelioma surgery in the past year. The mean annual number of cytoreductive procedures performed per surgeon was 8 and the mean number of mesothelioma patients seen annually at each medical center was 46.
Seventy-two percent of the survey’s respondents defined P/D as “resection of parietal and visceral pleura with the aim of achieving macroscopic complete resection.” However, in cases where the diaphragm or pericardium was also resected, 64 percent of the mesothelioma surgeons preferred the term “radical P/D”. If these structures were not removed, 40 percent of respondents called the procedure “P/D” while 39% called it “total pleurectomy”.
As for the effectiveness of the procedure, most surgeons surveyed believed that only extrapleural pneumonectomy (90%) or “radical P/D” (68%) could provide adequate cytoreduction of mesothelioma tumors. Only 23% thought that standard P/D could do this.
The authors of the study express concern at the variations they found in surgical nomenclature for P/D and suggest that the terminology for this mesothelioma surgery be standardized. The article concludes with the recommendation that “P/D should aim to remove all macroscopic tumor involving the parietal and visceral pleura and should be termed ‘extended P/D’ when the diaphragm or pericardium is resected.”
Sources: Rice, D et al, “Recommendations for Uniform Definitions of Surgical Techniques for Malignant Pleural Mesothelioma: A Consensus Report of the International Association for the Study of Lung Cancer International Staging Committee and the International Mesothelioma Interest Group”, August 2011, Journal of Thoracic Oncology, pp. 1304-1312.