Pleural-decortication (P/D) surgery is an attractive treatment option for patients diagnosed with mesothelioma. But the surgery includes an incision that may cause seeding—when tumour cells spread to other sites. A new surgical technique has been invented to mitigate the risk of seeding and prevent the recurrence of mesothelioma after P/D surgery.

How P/D Surgery Normally Works

Pleurectomy with decortication (P/D) is a lung-saving treatment for pleural mesothelioma patients. The goal of P/D is to remove cancerous tumors from the upper linings of the lung, the parietal pleura and visceral pleura (outer and inner layers). To increase the chance of survival and save the lung, a surgeon removes the entire plural lining.

P/D is one surgery completed in 2 parts. The first part of the surgery is a pleurectomy, where a surgeon opens the chest cavity and removes the pleural lining. The second part is decortication—where the surgeon scrapes away parts of the tumor left on the lung lining. The patient is then stitched up and stays in the hospital for around a week for monitoring.

The Risk of PD Surgery

Patients who undergo P/D treatment may have a longer life expectancy when compared to other pleural mesothelioma patients. P/D surgery has very few complications, low mortality rates and gives patients a better quality of life. For these reasons, P/D surgery is an attractive and viable treatment option for pleural mesothelioma patients.

However, at the beginning of pleurectomy, a sharp incision is made through the tumor to remove the parietal and visceral pleural from the rest of the lung. This incision may cause the spread or seeding of tumor cells into other parts of the body.

Non-Incisional P/D Surgery

Doctors have developed a new surgical technique for P/D that doesn’t involve a plural incision, reducing cancer spread and improving post-surgery survival rates.

The non-incisional P/D surgery is almost identical to the traditional P/D surgery, but without the initial pleural incision. Instead of an incision, a surgeon grasps the pleural lining near the root of the lung (where the lung attaches to the trachea) with their fingers wrapped in dry gauze. The surgeon then pulls the pleura away from the underlying lung parenchyma—the part involved in gas exchange, making up the different lobes of the lung. Any remaining part of the tumor is scraped away and the patient gets closed up.

Apart from the reduced risk of seeding, non-incisional P/D also minimizes the residual microscopic tumor left behind on the lining of the lungs.

Non-incisional P/D may be very successful for carefully selected pleural mesothelioma cases. The ability to remove the pleural lining without an incision will heavily depend on a patient’s tumor status, including the tumors volume, extent and thickness. Studies have shown that eligible patients for non-incisional P/D should have an appropriate parietal and visceral pleural thickness and minimal tumor spread into the lung.

Mitigating Recurrence With Non-Incisional P/D Surgery

Mesothelioma is a very difficult disease to treat due to its close proximity to vital organs. Unfortunately, recurrence occurs in most cases, but the key is to delay it for as long as possible while preserving a patient’s quality of life.

There are currently only two surgical treatments for pleural mesothelioma extrapleural pneumonectomy (EPP) and P/D. EPP is an extreme procedure that removes the infected lung, the pleural lining, the pericardium (lining around the heart) and parts of the diaphragm. In comparison to EPP, P/D has a lower mortality rate and is less taxing on the body.

Improved tumor extraction methods in a less invasive surgical treatment is very promising for the pleural mesothelioma community.

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Sources
  1. Gen Thorac Cardiovasc Surg, “Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma.” Retrieved from: https://link-springer-com.prxy.lib.unbc.ca/content/pdf/10.1007%2Fs11748-014-0389-7.pdf. Accessed on March 24, 2018.
  2. Surgery Today, “Non-incisional pleurectomy-decortication for malignant pleural mesothelioma.” Retrieved from: https://link-springer-com.prxy.lib.unbc.ca/content/pdf/10.1007%2Fs00595-018-1624-0.pdf. Accessed on March 24, 2018.

Last modified: September 1, 2018