There has been a long and heated debate among pleural mesothelioma experts about which surgical procedure is better: pleurectomy with decortication (P/D) or extrapleural pneumonectomy (EPP). However, a new study that looks into the short-term outcomes of both procedures leans towards P/D as the better option.

The Current Study

The study by Doctors Maaike van Gerwen, Andrea Wolf, Bian Liu, Raja Flores and Emanuela Taioli evaluated the 30-day mortality and complication rates of both EPP and P/D. They discovered that patients who had P/D had fewer complications, like supraventricular arrhythmias, from the procedure as well as lower levels of mortality. The researchers also point out that another benefit that P/D has over EPP is that it is the less invasive of the two pleural mesothelioma surgeries.

According to van Gerwen and the rest of the team, if a mesothelioma patient can undergo P/D, it may be the better option for them. Their finding could potentially change the standard-of-care for mesothelioma patients. The reason for that being the standard-of-care treatment is supposed to be the most effective treatment with the least amount of, or at least the most manageable, surgery side effects.

As more studies show P/D is more effective in the short-term and over an extended period, and that its side effects are less severe than those patients who receive an EPP experience, then P/D will become the go-to surgery form.

P/D vs. EPP Pleural Mesothelioma Surgeries

When a surgeon is operating on a patient with pleural mesothelioma, their goal is to remove all of the visible tumors from the lung lining. This removal can be done in one of two ways: pleurectomy with decortication or extrapleural pneumonectomy.

Pleurectomy/Decortication (P/D)

There are two parts to P/D. For the pleurectomy, the surgeon removes the pleura—lining of the lungs—and, if necessary, any other diseased tissue, such as parts of the pericardium or diaphragm. Then during the decortication, the surgeon removes any visible tumors on the surface of the lungs.

While P/D used to be a highly invasive surgery, some surgeons, such as Dr. Taylor Ripley perform it using robotic surgery, while others like Dr. Raja Flores use video-assisted thoracoscopic surgery (VATS) to operate. Both robotic surgery and VATS are minimally invasive, meaning the chances of severe side effects and the amount of time it will take a patient to recover are lower for patients who undergo these procedures than it is for patients whose incisions are larger.

Extrapleural Pneumonectomy (EPP)

In EPP the surgeon tries to achieve macroscopic resection—the removal of all visible diseased tissue—by taking out the affected lung, parts of the diaphragm, heart lining and lymph nodes. Then, once the diseased tissue has been taken out the surgeon will repair, or partially reconstruct the diaphragm and pericardium—the lining of the heart.

Difference Between Short-Term and Long-Term Outcomes

This current study looked at the short-term results for the two types of procedures. The reason it’s important to distinguish whether a study looked at short-term outcomes or long-term outcomes, is that the effectiveness of the surgery could be different in the beginning and after several months. One example of this would be recurrence rates.

While P/D has more manageable side effects and lower rates of postoperative mortality in the time right after the surgery, 63% of the patients who underwent this procedure will have the cancer return in the same place. EPP, on the other hand, has a much lower chance of recurrence on the same side of the body. Only 31% of patients who undergo EPP with have cancer come back on the same side of their chest.

Learn more about the differences between pleurectomy with decortication vs. extrapleural pneumonectomy and which of the two pleural mesothelioma surgeries is right for you.