The pleurectomy with decortication procedure is performed on patients with pleural mesothelioma, usually if they are in stage 1 or stage 2 of the disease.
The Lung-Sparing Mesothelioma Surgery
This is a lung-sparing procedure that removes the lining of the lung that has mesothelioma cells in it but doesn’t remove the lung itself, the diaphragm or pericardium. The surgery lasts about five hours.
The P/D is a two-stage procedure:
- First, the chest cavity is opened and mesothelioma tumor is seen and removed. The lining of the lung, called the pleura, is where this cancer begins so it is removed as part of the procedure.
- Second, any tumor masses visible inside the lung space are removed. This is called decortication. Because there are likely to be mesothelioma cells that are not yet visible, these patients are not expected to be cured by the procedure alone and often undergo chemotherapy and radiation to remove any remaining cancer cells. If mesothelioma cells are visible on the diaphragm or pericardium, these cells are also removed.
Pleurectomy with decortication typically does not cure mesothelioma, but may prolong the life of the patient. Those who have this procedure need to be in fairly good health in order to tolerate it. Sometimes doctors do lung function studies and cardiac stress tests to make sure the lungs and heart are healthy enough for surgery.
Historically, patients underwent pleurectomy alone as a type of palliative surgery meant to keep the patient more comfortable. With the addition of the decortication, some people have extended their lifespan because of the added measures of removing all visible mesothelioma cells in the lung cavity.
Because the lung is spared, people who have this procedure often do better after surgery than patients who receive the EPP, even though there is a higher chance of cancer recurrence with the P/D.
Recovery from Surgery
After the procedure, the patient can still have blood loss and a buildup of fluid around the lungs. Sometimes a chest tube is placed temporarily in order to drain the excess blood and fluid out of the surgical space for a few days. The chest tube is removed when there is no more drainage from this area. After surgery, patients practice deep breathing exercises to help expand the lungs and to prevent pneumonia from developing.
People who have the pleurectomy/decortication procedure still need several additional weeks to recover after leaving the hospital. This is far shorter than the several months required to heal from the EPP, so it is considered to give the patients a better quality of life in the months after surgery. Often people have chemotherapy and/or radiation after the surgery, which extends the lifespan of patients in all stages of mesothelioma.
Complications of this Procedure
More than 90 percent of people who undergo the P/D experience a decrease in symptoms after having the procedure. The mortality rate of this procedure in the days following surgery is about 1-2 percent. The biggest complication is a pneumothorax (air leak in the lungs), although bleeding and infection can occur as well.
The median survival of patients who receive the P/D is about 20 months. This means that half of all people live less than 20 months and half of all people live longer than 20 months. Because the survival rate is not much different from those who have an EPP, some doctors do not believe that the EPP should be done at all.
If chemotherapy and radiation are done along with surgery, known as a multimodal approach, people tend to live longer. As many cancer cells are left over after the procedure, these other treatments can help get rid of them. Radiation to the original site of mesothelioma can prevent a recurrence at that site.
In one study done in 2009, it was found that people who had all three forms of therapy had a median survival rate of around 30 months. This means that half of all people lived shorter than 30 months and half of all people lived longer than 30 months.
Origins of the Procedure
The P/D was developed by a thoracic surgeon, Dr. Robert Cameron. He works at the Pacific Meso Center and believes that this procedure is as good as any other procedure. He points out the past survival times as proof that mesothelioma can be effectively treated using the P/D along with chemotherapy and radiation. These patients seem to live a better quality of life over a longer period of time than ever before.
You can discuss this procedure and other available options, including the pros and cons of having each procedure, with the mesothelioma specialist you see for your disease.