There is...a degree of ambiguity about the extent of the procedure described in many published reports of P/D."
Raleigh, NC (PRWEB) September 11, 2013
In an article detailed on Surviving Mesothelioma, Dr. David Rice of M.D. Anderson Cancer Center points out that the primary types of mesothelioma surgeries currently mean different things to different surgeons. Although the steps of extrapleural pneumonectomy (EPP), the most radical mesothelioma surgery which involves removal of a lung, have been standardized, the same is not true for the lung-sparing procedures, pleurectomy/decortication (P/D) and extended pleurectomy/decortication (EPD).
“There is, therefore, a degree of ambiguity about the extent of the procedure described in many published reports of P/D, unless the authors have taken the time to specifically outline their definition of the procedure and the therapeutic intent,” observes Dr. Rice in an article in the Annals of Cardiothoracic Surgery. This ambiguity may be adding fuel to the fire in the controversy over the best mesothelioma approach.
Mesothelioma is an asbestos-linked cancer that starts on the pleura, the lining around the lungs, and can quickly spread to other parts of the body. There is worldwide disagreement between mesothelioma experts over the value of removing the most vulnerable lung during mesothelioma surgery, as opposed to leaving it in place. EPP advocates cite various studies showing that the more radical approach offers a survival benefit, despite the higher risk of complications and even death. Advocates of the more conservative lung-sparing approaches say these procedures can significantly improve mesothelioma symptoms without the pain and risk of EPP.
In response to a 2011 survey of surgeons who agreed that standardization was need, the International Association for the Study of Lung Cancer (IASLC) came up with the following definitions:
- EPP – Resection of the inner and outer pleura, the diseased lung, and the pericardium and/or diaphragm, depending on the extent of the tumor
- EPD – Resection of the inner and outer pleura, and/or all or part of the diaphragm or pericardium
- P/D – Resection of the inner and outer pleura
- Partial pleurectomy – Resection of portions of the inner and/or outer pleura with the primary goal of symptom relief
Dr. Rice says adhering to these definitions, especially in research studies, will make it easier to fairly compare the different surgical approaches and, ultimately, improve the prognosis for patients with malignant pleural mesothelioma. His original article was published in the Annals of Cardiothoracic Surgery. (Rice, David, “Standardizing surgical treatment in malignant pleural mesothelioma”, November 2012, “Annals of Cardiothoracic Surgery, pp. 497-501, http://www.annalscts.com/article/view/1054/1616)
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