Mesothelioma — Surgical Treatments
Understanding the two surgical options
There are two main types of surgical treatment for pleural mesothelioma:
- Extra-pleural pneumonectomy (EPP)—removal of the pleura, diaphragm, pericardium and whole lung involved with the tumor
- Pleurectomy/decortication (P/D)—removal of the pleura without removing the entire lung
Which treatment is recommended depends on many factors, including the stage of the tumor. (The National Cancer Institute has a detailed description of mesothelioma stages.)
However, it must be noted that it is unclear whether:
- EPP provides significantly greater benefits than pleurectomy/decortication
- Either is significantly more effective than non-surgical options
Study findings
A comprehensive study was conducted that followed 663 mesothelioma patients who, between 1990 – 2006, had pleurectomy/decortication, extra-pleural pneumonectomy (EPP) or thoracotomy.
The results were published in an article, “Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: Results in 663 patients,” by Raja M. Flores, MD, Harvey I. Pass, MD, Venkatraman E. Seshan, PhD, Joseph Dycoco, BA, Maureen Zakowski, MD, Michele Carbone, MD, Manjit S. Bains, MD and , Valerie W. Rusch, MD, The Journal of Thoracic and Cardiovascular Surgery, 2008. It indicated that:
“Our study emphasizes the similarities in outcome after EPP or P/D for MPM in a multicenter setting and do not allow us to advocate clearly for either one or the other surgical approach at the current time. Pending the development of more effective multimodality therapy, careful patient selection for both EPP and P/D on the basis of the cardiopulmonary function, extent of the tumor, and ability to resect all gross disease remains key to offering patients good treatment with acceptable risk. Given the limitations that EPP and P/D impose on the options for adjuvant therapy, we believe that the choice of surgical procedure must also take into account for each patient a multidisciplinary decision about the use of nonsurgical therapies.”
The authors also note that other factors influence how long people survived including:
- Stage and cell type of the tumor
- Gender of the patient
Surgery can provide symptomatic relief and sometimes the bulk of the tumor can be removed. Surgery is often used in combination with other treatments (known as multi-modal treatments), but its value is very limited if the tumor is near any vital organs.
Both EPP and P/D are complex surgeries, not performed frequently by most surgeons. They require referral to centers dedicated to such treatments. Many of these centers also specialize in other forms of mesothelioma treatment.
You should discuss referrals with your doctor.
Further information about radiotherapy and mesothelioma
- "The effect of extent of local resection on patients on patterns of disease progression in malignant pleural mesothelioma," by D.J. Stewart, et al in Annals of Thoraisc Surgery, July 2004; 78(1):245-252.
- “Malignant pleural mesothelioma: a population-based study of survival,” by Milano MT, Zhang H. (Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY), The Journal of Thoracic and Cardiovascular Surgery, 2010 Nov;5(11):1841-8.
- “Malignant pleural mesothelioma: clinicopathologic and survival characteristics in a consecutive series of 394 patients,” by Borasio P, Berruti A, Billé A, Lausi P, Levra MG, Giardino R, Ardissone F (University of Turin, Department of Clinical & Biological Sciences, Thoracic Surgery Unit, Italy), European Journal of Cardiothorac Surgery, 2008 Feb;33(2):307-13.
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