Treatment & Doctors

Symposium Touts Benefits of P/D Surgery

Written By:
May 17, 2012
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Written By: Tim Povtak,
May 17, 2012

Thoracic surgeon Dr. Robert Cameron, used his second annual Symposium for Lung-Sparing Therapies for Malignant Pleural Mesothelioma last week in Los Angeles, California, as a forum to lobby again for a less-radical approach to treating patients.

Cameron, director of the UCLA Mesothelioma Comprehensive Research Program, has been an outspoken critic of the popular Extrapleural Pneumonectomy (EPP) surgical procedure that some of his peers have been doing for years.

In direct contrast, Cameron has been the leading proponent for the lung-sparing pleurectomy and decortication (P/D) surgery, which is a less extensive, but a longer, more-detailed surgery.

Both are used in the treatment of pleural mesothelioma patients who are strong enough to endure a lengthy surgical procedure. Mesothelioma is the aggressive cancer that is caused by an exposure to asbestos. It has no cure.

P/D Procedure Considered More Effective than EPP

EPP involves removal of an entire lung, the lung lining, part of the diaphragm and part of the lining surrounding the heart. The P/D surgery involves removal of the lining around the lung and separating any tumors from the lung.

P/D has a lower rate of surgical mortality and allows the patient to retain both lungs, which should better preserve the quality of life remaining.

“My philosophy has always been ‘do no harm.’ Taking out a lung does harm and there is absolutely no benefit to the patient,” Cameron states on the Pacific Meso Center website. “Doing a bigger operation makes no sense from an oncology standpoint.”

Cameron for years has lobbied against doing EPP surgery. His support has grown in recent years as other surgeons have joined his way of thinking.

The faculty at his symposium last week included Dr. Raja Flores from Mt. Sinai Medical Center, who spoke about his change of thinking regarding the two procedures; Dr. Anne Tsao from M.D. Anderson; Dr. Courtney Broaddus from the University of California-San Francisco; and Dr. Jim teWaterNaude from the University of Cape Town, who spoke about the asbestos situation in South Africa.

P/D Surgery Popular in Europe

Earlier this year, the International Association for the Study of Lung Cancer in London published its own study that showed the P/D surgery had become the preferred standard of care in Europe.

Many of the examples cited in the April 2012 issue of Journal of Thoracic Oncology had backed up the beliefs that Cameron has talked about for many years.

English surgeon Loic Lang-Lazdunski, who led the study in London, told that the EPP procedure should be abandoned for the treatment of mesothelioma.

Cameron is the driving force behind the newly-created Pacific Meso Center, the first free-standing international mesothelioma research laboratory in the world. It is a division of the Pacific Heart, Lung and Blood Institute, and is focused on the treatment and prevention of pleural mesothelioma.

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