One of the most frequently-debated issues amongst those providing treatment of malignant pleural mesothelioma is whether to a conservative surgical approach called pleurectomy decortication (PD) or the more aggressive extra pleural pneumonectomy (EPP) procedure that removes the entire lung. Each technique has its proponents, but a recent study conducted at the Icahn School of Medicine at Mount Sinai in New York have led researchers to land on the side of the more conservative approach.
Writing in the Journal of Surgical Oncology, author Emanuela Taioli, MD, PhD describes his group’s analysis of data from the New York Statewide Planning and Research Cooperative System (SPARCS) regarding the 30-day mortality rate among 500 patients diagnosed with malignant pleural mesothelioma and undergoing both types of surgery. In looking at the differences in survival between patients who had pleurectomy decortication and those who had extra pleural pneumonectomy, the group found that the difference in post-surgical deaths and complications between the two procedures was insignificant immediately after the surgery, but that things changed quickly once patients were released from the hospital. Once they were home, almost half of the patients who had the aggressive surgery developed serious complications, while that was true of only 24% of those who’d had the lung-sparing surgery. The most common of these complications was heart arrhythmia which the patients undergoing aggressive surgery experienced at four times the rate. Based on these findings, Taioli wrote, “Postoperative mortality, postoperative complications, and particularly supraventricular arrhythmia are less frequent after PD vs. EPP. PD, a less invasive surgery, may provide a better option when technically feasible for patients with malignant pleural mesothelioma.”
The overarching conclusion that the researchers reached is that mesothelioma patients electing to have surgery are likely to have a better experience with fewer debilitating or dangerous side effects if they choose the less aggressive surgery than the more aggressive version. Many physicians around the world have come to the same conclusion, but the extra pleural pneumonectomy procedure continues to have many proponents. If you have been diagnosed with malignant pleural mesothelioma you need access to as much information and as many resources as possible in order to make an informed decision. If you need help with understanding the choices available to you, contact the Patient Advocates at Mesothelioma.net at 1-800-692-8608.