Pleurectomy and Decortication Surgery

Pleurectomy and Decortication (P/D) is a surgical method designed to treat pleural mesothelioma. The procedure comprises two key parts: pleurectomy, which involves the removal of the pleura (the lung lining), and decortication, focusing on excising tumors or fibrotic tissue from the lung surface. Significantly, P/D is categorized as a lung-conserving procedure, as it does not involve the removal of the lung itself.

How Does P/D work?

Pleurectomy/Decortication is a dual-phase operation. The first phase, pleurectomy, is the extraction of the pleura. Following this, decortication is performed to remove any abnormal tissues, such as tumor growths or scar tissue, on or around the lung. This procedure is typically utilized in the treatment of pleural mesothelioma, a malignancy associated with asbestos exposure.

Pleurectomy’s Role in Mesothelioma Management

In treating pleural mesothelioma, P/D serves to remove cancerous tissues. This includes the surgical extraction of the lung’s external lining and the visible tumors within the chest area. The ultimate goal of P/D, along with other mesothelioma surgical treatments, is achieving macroscopic complete resection (MCR), which entails the removal of all tumor tissues visible to the eye.

Different Forms of P/D

The American Society of Clinical Oncology (ASCO) outlines two principal forms of P/D:

1. Regular Pleurectomy/Decortication: Entails the removal of both the parietal and visceral pleura.
2. Extended Pleurectomy/Decortication (ePD): Involves the removal of both pleura layers and cancerous parts of the diaphragm and heart lining.

Surgical Steps in P/D

P/D is conducted in stages, usually lasting between four to six hours. The procedure is carefully executed to ensure the integrity of vital chest structures while removing the pleura and any cancerous tissues.

Recovery Phase Post-P/D

Recovery after P/D involves a hospital stay, often in the ICU, for close observation. The use of a chest tube is common to manage fluid and air in the chest. Recovery continues at home, potentially lasting from weeks to months.

Risks and Side Effects of Pleurectomy and Decortication

While P/D is a critical surgical procedure, it carries inherent risks such as blood loss, air leaks, and complications like pneumonia or respiratory failure. These risks are typically well-managed by the surgical team. According to the National Library of Medicine, The most common significant issues observed included respiratory failure (ranging from 2.3% to 7.1%) and bleeding (ranging from 0.0% to 16.7%). Paying close attention to the intraoperative ventilator strategy and adopting a systematic approach to handle bleeding during the procedure can play a significant role in decreasing the occurrence of these complications.

Benefits of P/D in Mesothelioma Treatment

P/D offers numerous advantages for mesothelioma patients:

1. Reduced short-term mortality risk compared to other surgical options.
2. As a lung-sparing surgery, P/D is generally considered safer.
3. Preservation of both lungs potentially enhances life quality post-surgery.
4. Eligibility for P/D is often broader compared to other surgical treatments like EPP.

Comparative Analysis: P/D and Extrapleural Pneumonectomy

While both P/D and extrapleural pneumonectomy (EPP) are options for surgical treatment in mesothelioma, P/D is often preferred due to its lower risk profile and comparably effective outcomes.

Prognosis and Survival After P/D

The prognosis and survival rates following P/D vary based on several factors, including the stage of mesothelioma and the overall treatment approach. Combinations with other treatments like chemotherapy have shown to enhance survival rates significantly.

Determining Suitability for P/D

The decision to undergo P/D is based on a variety of criteria, such as the mesothelioma stage and the patient’s overall health. Originally viewed primarily as a palliative measure, P/D is now increasingly recognized as an effective surgical option for pleural mesothelioma treatment.