In addition to site-specific cyto-reductive surgery, doctors have for years performed radical and extremely dangerous extrapleural pneumonectomies as a first line oftreatment for mesothelioma. The procedure, which includes the removal of the entire lung, the diaphragm, and the membrane surrounding the heart, has been controversial—to say the least—and several studies have pointed out the high mortality rate and the lowered quality of life in patients who undergo this last-ditch surgery as reasons to discontinue its use.
However, a similar but less invasive surgery is growing in popularity amongmesothelioma doctors who advocate surgery for their patients. Pleurectomy/decortication is a procedure which includes the removal of the pleura—the soft tissue membrane that surrounds the lungs. The procedure leaves the lungs and diaphragm intact and has displayed some promising results.
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| Pleurectomy Decortification Surgery on a Mesothelioma Patient |
In fact, in an editorial published in the April 2012 edition of the Journal of Thoracic Oncology, Dr. Michael Weyant wrote and impassioned piece advocating this surgery as an alternative to the more dangerous procedure.
Weyant wrote that mesothelioma patients who do choose to undergo this procedure tend to live longer and have a much higher quality of life than their counterparts. Weyant drew on a study which examined two groups of several mesothelioma patients who underwent either procedure in addition to chemotherapy between January 2008 and June 2011. The data showed that those who underwent the less invasive procedure of pleurectomy/decortication outlived the others and were healthier overall.
In fact, two years after their surgery, a full half of the P/D patients were still alive compared to only 18% of those who underwent the full extrapleural pneumonectomy (EPP). That survival ratio was carried over to the 5-year benchmark as well: 30% of the P/D patients were still alive when compared to just 9% of the EPP patients.
However, Weyant recognized that some mesothelioma patients could be better treated through EPP. The decision, he argued, should ultimately be made on a case by case basis where both the mesothelioma surgeon and the patients weigh the risks, the rewards, and their expectations for the remainder of their lifespan prior to determining which option would best suit them.
As is the case so often with cancer, mesothelioma affects everyone differently and a number of factors including prior medical history, current health statistics, and future expectations come into play when deciding on the proper course of treatment.
However, the case for P/D is growing as EPP becomes less and less popular overtime. A Recent MARS study concluded that often the risks associated with EPP, including the greatly increased death rate up to six months after the surgery, outweigh the benefits. Many doctors have begun to see extrapleural pneumonectomies as a last-ditch effort to prolong life no matter the risk.
Regardless of the type of surgery(if surgery is an option at all,) many mesothelioma patients still must undergo multiple rounds of chemotherapy and radiation treatments to combat asbestos cancer. Currently, there are roughly 3,000 new cases of mesothelioma diagnosed every year in the United States.
source & image credit:http://blog.mesothelioma-usa.com
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