Mesothelioma, a cancer caused by exposure to asbestos, is a notoriously aggressive disease with limited treatment options. However, recent research from the Mount Sinai Health System in New York offers hope for patients battling this illness.
A November 2021 research review led by Dr. Kimberly J. Song and Dr. Andrea S. Wolf explored the surgical options available for malignant pleural mesothelioma.
Pleural mesothelioma is the most common form of mesothelioma affecting the pleura, the lining of the chest cavity. Due to its fast progression, pleural mesothelioma has a median survival time of only 7 months if untreated.
The Traditional Approach to Pleural Mesothelioma
Traditionally, there have been two main surgical approaches for treating malignant pleural mesothelioma: radical pleurectomy/decortication (PD) and extrapleural pneumonectomy (EPP). Both surgeries aim to remove as much cancerous tissue as possible, but each method has advantages and challenges.
Extrapleural Pneumonectomy (EPP)
Extrapleural Pneumonectomy completely removes the affected lung, pleura, diaphragm, and pericardium (the sac surrounding the heart). While EPP was one of the early surgical treatments for malignant pleural mesothelioma, it carries significant risks and high perioperative mortality rates (deaths occurring around the time of surgery).
Due to these risks and the aggressive nature of pleural mesothelioma, some mesothelioma doctors have shifted their preference toward the less invasive PD procedure.
Pleurectomy With Decortication (PD)
Pleurectomy with Decortication involves the removal of the pleura and any visible tumor while preserving the lung. The review by Dr. Song and Dr. Wolf highlights that PD has become increasingly favored over EPP due to its lower associated mortality rates and potential for improved long-term survival.
Despite its advantages, PD is still a complex procedure requiring careful patient selection and postoperative care.
To gather data on PD and its outcomes, the researchers reviewed surgical articles published between 1990 and 2020.
Their analysis revealed that PD can effectively reduce the tumor burden in patients with pleural mesothelioma and that it is often a suitable option for those with good overall health and limited tumor spread. However, they also emphasized the need for a thorough preoperative evaluation to determine the best treatment plan for each individual patient.
While PD has shown promise, the researchers noted that there is still a lack of high-quality evidence comparing PD to EPP. As such, the best surgical approach for pleural mesothelioma remains a subject of debate within the medical community.
To provide the most effective care, the researchers recommend that treatment decisions be made on a case-by-case basis, considering factors such as the patient’s health, tumor characteristics, and treatment goals.
Important Factors for Managing Pleural Mesothelioma
The authors also stressed the importance of seeking treatment at a high-volume center with experience in managing pleural mesothelioma.
According to data from the Surveillance, Epidemiology, and End Results (SEER) program, only 22% of patients receive cancer-directed surgery at non-specialized centers, despite surgery being associated with longer survival times when combined with other therapies such as chemotherapy, radiation, and immunotherapy.
The review underscores the need for continued research and collaboration among medical professionals to refine surgical techniques, improve patient outcomes, and expand treatment options for those living with mesothelioma.
Mesothelioma remains a challenging disease to treat, but advances in surgical approaches like PD are providing new hope for patients and their families. As research continues to shed light on the most effective treatments, the medical community is committed to providing the best care possible for those affected by this aggressive cancer.