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The Role of Surgery in Pleural Mesothelioma

ByHolly Zink
The Role of Surgery in Pleural Mesothelioma

Pleural Mesothelioma is a rare and aggressive cancer caused by asbestos exposure. The outlook for this disease is often poor, with a typical survival time of 9 to 20 months after treatment. The overall 5-year survival rate is around 5%. However, new treatments that include surgery are helping improve these numbers. A new article from Cancers explains how surgery helps in diagnosing, staging, and treating pleural mesothelioma.

Importance of Surgery in Diagnosis and Staging

Surgery is very important for diagnosing and staging pleural mesothelioma accurately. During surgery, doctors can take tissue samples to confirm the disease and identify its type. Correct staging, which means figuring out how far the disease has spread, is crucial for planning the right treatment. 

Major health organizations recommend surgery as a key part of treatment for pleural mesothelioma. There are a variety of surgical procedures and treatments for pleural mesothelioma.

Types of Surgeries for Pleural Mesothelioma

Pleurectomy/Decortication (PD) is a surgery that removes the lining of the lungs and chest wall. The goal is to take out as much of the tumor as possible while keeping the lungs working. PD is safer and has fewer risks than more radical surgeries.

Extra-Pleural Pneumonectomy (EPP) is more extensive and removes the affected lung, part of the diaphragm, the lining of the chest, and sometimes part of the heart’s lining. While it can completely remove the tumor, it has higher risks and a longer recovery time.

Extended Pleurectomy/Decortication (ePD) is a more thorough version of PD, aiming to remove all visible and touchable tumor tissues.

Why Surgery is Important

The main goal of surgery is to achieve Macroscopic Complete Resection (MCR), which means removing all visible tumors. This significantly improves survival rates.

Combining surgery with treatments like chemotherapy, radiation, or immunotherapy can lead to better long-term survival by targeting any remaining microscopic disease. Perhaps the greatest area of dispute now is whether an extrapleural pneumonectomy (EPP) or pleurectomy / decortication is the most appropriate curative operation for mesothelioma patients who are candidates for both procedures.

Surgery helps identify the specific type of mesothelioma, which is important for planning the best treatment and understanding the prognosis.

Not all patients are suitable for surgery. Doctors must carefully select patients based on the stage of their disease, type of mesothelioma, overall health, and lung and heart function. Surgeries should be performed at specialized centers with experienced teams to minimize risks and improve outcomes.

In cases where curing the disease is not possible, surgery can still help improve the patient’s quality of life by relieving symptoms like fluid buildup in the chest.

Looking Forward

Surgery is a crucial part of diagnosing, staging, and treating pleural mesothelioma. While new treatments are developing, surgery remains key in improving outcomes for patients. Achieving complete tumor removal through procedures like pleurectomy/decortication or extra-pleural pneumonectomy can significantly extend survival, especially for patients with specific types of mesothelioma. 

As research continues, the role of surgery will keep evolving to enhance treatment effectiveness for mesothelioma patients.

Source:

Lapidot, Moshe, and Martin Sattler. “The Role of Surgery in Pleural Mesothelioma.” Cancers 16, no. 9 (January 2024): 1719. https://doi.org/10.3390/cancers16091719.

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