Pleurectomy/Decortication Mesothelioma Surgery Is Best

If your mesothelioma doctor offers you a choice between extrapleural pneumonectomy or pleurectomy/decortication for treating your pleural mesothelioma, look to the latter surgery choice.

That’s the advice of a trio of mesothelioma doctors writing in the December 2014 issue of the journal Annals of Thoracic Surgery and hoping to end the debate about which surgery extends mesothelioma survival the longest.

Each of the two surgeries comes with its own advantages and disadvantages. However, according to this newest research, pleurectomy/decortication tends to deliver the superior result in most patients.

Mesothelioma Surgery Question Explored

The question at the center of the debate wasn’t easy to answer.

That’s because mesothelioma patients can’t chose one surgery type and then, if it doesn’t deliver a satisfactory result, try the other type. Mesothelioma patients only get a single shot at it.

So for each mesothelioma patient who received an extrapleural pneumonectomy, the researchers had to try to find a pleurectomy/decortication recipient whose medical status was a close match.

That way the researchers would be able to make apples-to-apples comparisons to the fullest extent possible.

The investigators ended up performing a meta-analysis of earlier research that evaluated the results of 1,512 pleurectomy/decortication cases and 1,391 extrapleural pneumonectomy cases.

The 2,903 combined cases were culled from 24 distinct data sets. All of the earlier studies evaluated the long-term outcomes of the two types of surgeries and covered a 14-year period that began in 1990.

“The combined percent perioperative and two-year mortality, and median survival were calculated according to both a fixed and a random effect model,” the researchers wrote.

“There was no statistically significant difference in two-year mortality between the two groups, but there was significant heterogeneity,” they added.

Ultimately, the researchers observed a 2 ½-fold lower short-term mortality rate among mesothelioma patients who underwent pleurectomy/decortation.

In other words, the pleurectomy/decortation recipients lived longer.

“Pleurectomy decortication should therefore be preferred when technically feasible,” the researchers wrote.

The Two Types of Mesothelioma Surgery

Pleurectomy/decortication — often abbreviated as P/D — entails removal of the lining of the lungs, but not the lung itself.

For that reason, P/D is referred to as a lung-sparing procedure. Because the lung stays in place, mesothelioma patients usually make a quick recovery from the surgery.

Extrapleural pneumonectomy — EPP, for short — goes further. The lining is removed as in a P/D, and the lung gets removed as well. That can be brutally hard on mesothelioma patients.

Given these differences between the two procedures, it’s easy to see why mesothelioma doctors would be embroiled in debate over which is better — because, if EPP is brutally hard, it ought to deliver results that make undergoing it worthwhile.

And, indeed, there have been some studies indicating that EPP extends mesothelioma survival. Not enough, however, to outperform P/D.

But this big new meta-analysis theoretically should put the debate to rest. Certainly that’s what the authors expect will happen.

Those researchers, by the way, are Emanuela Taioli, M.D., Ph.D., Andrea Wolf, M.D., and Raja M. Flores, M.D. Taioli teaches at Hofstra North Shore-LIJ School of Medicine and is the chief of epidemiology for the North Shore-LIJ Health System. She is also senior investigator at the Feinstein Institute for Medical Research. Wolf and Flores are affiliated with the Mount Sinai Health System in New York City.