Curative Mesothelioma Surgery: Pleurectomy-Decortication

Despite decades of research and medical development, mesothelioma remains an incurable disease in medical communities. Because of this, emphasis is placed primarily on early detection, management therapies, and means to prevent public inhalation of asbestos (since mesothelioma is directly caused by asbestos exposure). Conventional cancer treatment is most often recommended, including chemotherapy, radiation, and surgical treatments. Mesothelioma lawyers highlight the curative potential of pleurectomy-decortication, a surgery used to extend survival and improve quality of life.

The most efficient procedures for such a surgery are widely debated, partly because it is still considered a radical treatment, and partly because such a small number of people have undergone the surgery. Pleurectomy-decortication is recommended for patients in the initial stages of mesothelioma and is one of two major curative surgeries. The other, extrapleural pneumonectomy, completely removes the affected lung and surrounding tissue.

Most medical experts and mesothelioma patients prefer pleurectomy-decortication because it spares the lung. The surgery does remove the affected membrane lining of the lung along with the mesothelioma tumors, however, because mesothelioma tumors are especially interconnected with healthy tissues, the operation can prove extremely difficult.

For the past two years, Dr. Robert E. Cameron, Director of the UCLA Mesothelioma Comprehensive Research Program, has held a symposium to discuss pleurectomy-decortication and other lung-sparing therapies. The symposium is attended by the world’s top experts who aim to advance the treatment of mesothelioma.

A study by the Memorial Sloan-Kettering Cancer Center in New York examined the efficacy of both mesothelioma curative surgeries. They performed a multi-institutional study to increase statistical power to detect significant differences in outcome between the two. From 1990 to 2006, over 660 patients underwent resection at 3 separate institutions. The operative mortality was 7% for extrapleural pneumonectomy, and 4% for pleurectomy-decortication.

The study concluded that patients who underwent pleurectomy-decortication had better survival than those who underwent extrapleural pneumonectomy; however, the reasons are multifactorial and subject to selection bias. They recommended that, at present, the choice of resection should be tailored to the extent of the disease, any other diseases the patient might have, and type of multimodality therapy planned.

The parietal pleuron is the initial target during pleurectomy-decortication, including its surrounding area. The diaphragm is often removed in this process as it is one of the first places mesothelioma spreads to. Next, the surgeon attempts decortications of the lung, which entails removal of the visceral pleura and membrane of the lung. At this point a number of issues can interfere with complete cancer removal, including the inability to separate the affected areas safely from the lung. As previously mentioned, mesothelioma tumors are significantly entwined with healthy tissue, so surgery of this magnitude is often compromised by the danger of removing or damaging the healthy, necessary tissue. Any manipulation of the visceral pleura poses the risk of damaging the lung, so doctors must balance this risk during surgery.

After the tumor removal, a reconstructive process is necessary to ensure adequate lung function. If the diaphragm or other organs were removed, doctors must reconstruct the original structure. Following this, drainage tubes are inserted in various places to aid in fluid diffusion, proper lung expansion and retraction, and patient recovery. After final reconstruction procedures, the patient is moved to intensive care for a few days of monitoring, followed by rehabilitation and post-operative healing.

As with all surgeries, especially of this magnitude, some complications may occur during, before or after treatment. Pleurectomy-decortication is designed for patients with locally-contained mesothelioma, though it has been administered as a palliative treatment in some cases. Researchers suggest that future clinical trials should stratify for histological type and must consider the impact of type of surgical resection on the pattern of relapse.

Ultimately, the choice to undergo conventional mesothelioma treatments is an individual or familial decision.Mesothelioma attorneys understand the devastating nature of this disease and are available to help with any questions or concerns relating to its treatment, causes, or available legal options.

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