Mesothelioma is a rare but aggressive type of cancer caused by continued exposure to asbestos. This natural mineral can be woven and mixed into cement and it was widely used for about 100 years in industries like construction, shipbuilding and manufacturing due to its heat resistance, tensile strength and insulating properties. However, during the 20th century, the toxicity of the material was proven. When disturbed, asbestos fibers are released into the air and can be swallowed or inhaled.
These fibers cannot be properly expelled by the body and they become attached to the mesothelium, a thin membrane of mesothelial cells that protect and moist certain organs. With time, the asbestos fibers start to irritate the cells, causing the formation of tumors. It most likely occurs in lungs, being called pleural mesothelioma. But it can also develop in the abdomen, heart and testicles, which are known as peritoneal mesothelioma, pericardial mesothelioma and testicular mesothelioma respectively.
Pleurectomy / Decortication (P/D) Surgical Procedure
There is currently no cure for mesothelioma but there are treatment options meant to improve the symptoms and increase lifespan. Pleurectomy / decortication (P/D) is among the surgical options for patients with pleural mesothelioma. Before the surgery, patients undergo a series of exams to evaluate the eligibility for a pleurectomy / decortication, which include a fitness exam to measure overall health, blood tests to assure proper clotting, a pulmonary function evaluation to check the safety, a CT scan or MRI to locate the tumor in the chest, an echocardiogram to assess the cardiac function and a pleural biopsy to confirm the diagnosis. When the patient is cleared for surgery, it is conducted with the patient asleep under general anesthesia to prevent any pain.
This major, aggressive surgery has two parts and is also known as lung-sparing surgery. First, the pleurectomy consists of the removal of the lining of the lung, the pleura. Following this step, the decortication consists of the removal of any tumor masses growing inside the chest cavity. It is a long and difficult procedure that takes about five hours, but it saves the patients’ lungs. The pleurectomy / decortication is usually preferable in patients with good overall health and who are still in the first phases of the disease. Pleurectomy used to be a procedure performed alone, but the decortication was made possible by recent advancements in the field. In addition, it may be combined with chemotherapy and / or radiation therapy to improve the results.
Benefits and Risks of Pleurectomy / Decortication (P/D)
Pleurectomy / decortication is often referred as the closest treatment to a cure given its effectiveness. Patients who undergo this type of surgery usually experience relief in symptoms like pain, cough, shortness of breath, pleural masses and pleural effusions, as well as increase in their quality of life. The success rate of a pleurectomy / decortication is about 90%, while it has a low mortality rate placed between one and two percent. In addition, studies reveal that a pleurectomy / decortication increase median survival to 20 months, the equivalent to a year more than expected without the procedure.
Additionally, when combined with other treatment options, the survival may be even longer, with the better results associated with a multimodal treatment plan. This is explained by the fact that chemotherapy and radiation therapy are able to kill cancer cells that weren’t removed during the surgery and prevent recurrence. However, it does apply to all mesothelioma patients since when the cancer has metastasized, the effectiveness of a pleurectomy / decortication decreases. Like any other surgery, there are risks associated with a pleurectomy / decortication. The heart and rest of the body are put under stress, while the immune system is also impacted. Complication rates are, however, low, with the most common complication being prolonged air leak, which occurs in 10% of the patients.
Recovery and Life after Pleurectomy / Decortication (P/D)
Following the surgery, the patient needs to stay in the hospital for about a week, during which physicians and nurses will monitor the overall health. The patient will awake when the effect of the anesthesia fades and will be moved to a recovery room, where the heart rate, respiration rate, blood pressure and temperature are regularly checked. However, patients remain on a ventilator to assist them in breathing. The machine delivers oxygen through a tube placed in the mouth, nose or small hole in the neck, into the lungs. The ventilator is removed when the patient’s vitals are stable. The patient also continues with an IV tube that delivers medication in the case of pain, muscle fatigue or kidney problems.
During the recovery process, patients are submitted to numerous tests. A chest tube is used to inflate the lungs and drain any fluid left that may cause bacteria or infections. Physicians run a breathing trial to evaluate the health of the lungs, while coughing exercises are used to prevent fluid buildup and strengthen the diaphragm. Before going home, patients undergo a second pulmonary function test and complete blood count tests. The recovery continues at home and it takes a few weeks for patients to return to work. Complementary rehabilitation treatment is possible in the case of pain or other symptoms after the surgery.
Note: Mesothelioma Research News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.