Advantages and Disadvantages of a Pleurectomy Decortication for Pleural Mesothelioma
April 18, 2011
A 2011 review of 11 previously published papers concluded that in the treatment of malignant pleural mesothelioma, surgical removal of the tumors may be more effective at extending a patient’s life span than palliative care.
In the comparison of pleurectomy decortications (P/D) and palliative treatment, the former exhibited a higher median survival rate than supportive care, yet it was also accompanied by a higher risk for complications or post-operative mortality.
Developed by Dr. Robert Cameron, a pleurectomy decortication is an operation that removes all or part of the lining of the lung along with the attached mesothelial tumors. A P/D may be termed “radical,” removing the entire pleura, or “non-radical”, extracting up to 70 percent of the affected lining. Other surgeries or chemotherapy meant to alleviate malignant mesothelioma symptoms or extend a patient’s life span without the intention of a cure are considered to be palliative measures.
In the UK study, which was published in Interactive Cardiovascular and Thoracic Surgery, researchers sought to determine whether a P/D was superior to palliative measures for malignant pleural mesothelioma after the consideration of three factors: morbidity, symptom control and survival rates.
The reports, which were published between 1950 and 2010, revealed that patient outcomes after a P/D were favorable to supportive therapy. A radical P/D had a median survival period of 17.2 months, while a non-radical P/D yielded a median survival period of 8.1 months. Patients who underwent no form of surgery lived for an average of 6.8 months.
While the survival rates were higher in the patients who underwent a radical P/D, the associated 90 day mortality rate was also significantly higher. The mortality rates for radical and non-radical pleurectomy decortications were 55 percent and 28 percent, respectively. Although a P/D was found to manage malignant mesothelioma more effectively, it also was associated with more respiratory complications and a longer hospital stay (12 days for a radical operation and 10 for a non-radical surgery.)
Researchers concluded that the mortality and complication rates associated with a pleurectomy decortication may counteract the benefits of the procedure. Although a P/D is one of the less radical surgical treatments for mesothelioma, adequate considerations should be taken before incorporating it into a patient’s treatment regimen.