There are a number of treatments available for pleural mesothelioma including radiotherapy, chemotherapy and surgery. For patients who opt for surgery, there are a few different surgeries they can choose, although it may be dictated by the size and location of their tumour(s).
Pleurectomy/decortication
A common surgery for pleural mesothelioma is a pleurectomy or decortication. This is where the lining of the lung, the pleura, is removed. In some cases, the operation can be done through keyhole surgery. The aim of the procedure is to reduce chest pain, fluid build-up and breathlessness.
Extrapleural pneumonectomy
A more radical surgery is an extrapleural pneumonectomy. For patients diagnosed with pleural mesothelioma at an early stage, this is often an option. The surgery involves removing the pleura and the lung. As it is a major operation, patients need to be in relatively good health to be eligible for this treatment.
The goal of surgery for mesothelioma is to remove as much of the tumour as possible and achieve macroscopic complete resection.
Extrapleural pneumonectomy losing favour
A recent study has looked at the popularity shift from extrapleural pneumonectomy to pleurectomy/decortication.
Researchers studied the medical records of 355 patients with pleural mesothelioma between 2007 and 2015. They found that the most common complications included prolonged air leak, deep vein thrombosis, atrial fibrillation and pneumonia but these were low grade complications.
In 304 of the patients, macroscopic complete resection was achieved.
They concluded that pleurectomy/decortication has a low mortality rate with low grade complications.
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Source:
Lapidot M, Gill RR, Mazzola E, et al. Pleurectomy decortication in the treatment of malignant pleural mesothelioma: Encouraging results and novel prognostic implications based on experience in 355 consecutive patients. Ann Surg. Published online December 3, 2020. doi: 10.1097/SLA.0000000000004306