The P/D – A Lung-Sparing Surgery
Pleurectomy with decortication (P/D) is one of two surgical procedures used to treat pleural mesothelioma. P/D is a lung-saving procedure that allows the patient to keep their lung. This minimizes future challenges involving strenuous activity. P/D helps increase patient life expectancy and improves quality of life.
The other surgical procedure for pleural mesothelioma is called the extrapleural pneumonectomy (EPP). This procedure involves removing the diseased lung.
P/D has proven to be a safe and highly successful method of treating pleural mesothelioma. It has shown to increase patient life expectancy with a median survival time ranging between 9 and 20 months after surgery.
What is Pleurectomy with Decortication?
The pleurectomy with decortication removes as much of the mesothelioma as possible. It allows the lung to re-expand, reducing tightening in the chest and making it easier for patients to breathe.
P/D is considered by some to be a better alternative to EPP because it is not as extensive. EPP removes the lung, the pleura, the pericardium (lining covering the heart) and a portion of the diaphragm. The chest cavity is then reconstructed using synthetic materials.
Recovery from EPP can be much more difficult for many patients. It can also limit their activity and lifestyle afterward the procedure. Therefore, many doctors today believe that P/D gives patients a better post-op quality of life.
The first step in the pleurectomy with decortication treatment procedure is the pleurectomy. During a pleurectomy, the surgeon removes the diseased pleura from the pleural mesothelioma patient.
The second step in the pleurectomy with decortication treatment procedure is decortication. This refers to the process of removing the tumor masses within the chest cavity.
Goals of Pleurectomy with Decortication
Pleurectomy with decortication (P/D) is almost always used as a curative surgery for early-stage pleural mesothelioma. However, it has been performed on patients in later stages of mesothelioma to help alleviate their symptoms and make them feel more comfortable.
As a curative surgery, (P/D) can have the following treatment goals:
- Remove the diseased pleura to help reduce painful symptoms
- Remove tumor masses to prevent mesothelioma from spreading
- Extend patient’s life expectancy
- Help the patient reach remission
Removing as much of the tumor as possible is an important treatment approach. This is because it eliminates a large source of the patient’s symptoms and slows down the progression of the disease. It is very common for doctors to use chemotherapy or radiation therapy after surgery to kill any remaining mesothelioma cells that were not removed during decortication.
A pleurectomy is sometimes performed on patients with stage 3 or 4 mesothelioma as a palliative therapy. This procedure helps control fluid buildup in the chest, alleviating chest pain and improving breathing. However, when used as a palliative therapy, the procedure cannot remove the tumors entirely.
Pleurectomy with Decortication Surgery Candidates
Pleurectomy with decortication is used as a treatment for certain eligible patients. Generally, these are younger patients in stages 1 or 2 of pleural mesothelioma.
Patients in later stages do not benefit from this surgery. This is because the mesothelioma has spread too far or the tumors have hardened to the point where they cannot be removed from the pleura without causing damage to the lung.
All surgeries present risks. Therefore, doctors make sure their patients are healthy and physically fit enough to withstand surgery. This improves the P/D surgical success rate and lowers the risk of operative mortality.
Most patients make a full recovery from their P/D surgery within one month. A critical part of a successful recovery is working with a physiotherapist. Physiotherapists teach patients physical exercises that improve their mobility and breathing so they can go on to live healthy and active lives.
Talk to your health care team about pleurectomy with decortication surgery and how it can help increase your life expectancy and improve your quality of life.