Surgery
There are two surgical approaches to mesothelioma, pleurectomy/ decortication (P/D) and extrapleural pneumonectomy (EPP). These are extremely specialized surgeries, and may not be offered at all facilities. Not all thoracic surgeons have expertise in these types of surgeries. The ultimate goal of these procedures is the removal of all gross disease, with the knowledge that residual microscopic disease will most likely remain.
Adjuvant therapy, in which additional forms of treatment are used along with the primary therapy, is typically aimed at the elimination of this residual disease. The most common forms of adjuvant therapy are chemotherapy and/or radiotherapy.
Pleurectomy/decortication is considered the less radical of the two approaches since it involves only the removal of the pleura (lining of the lung) without resecting the underlying lung. In some cases, the pericardium and diaphragm may be removed, dependent on the extent of the tumor. Advantages of this procedure are a generally quicker recovery time, and usefulness for patients who may not be able to tolerate the more radical EPP. Disadvantages include an increased risk for recurrence of the disease because of inability to remove all cancerous tumor, and inability to use high dose adjuvant radiation because of potential damage to the underlying lung.
Extrapleural pneumonectomy is a more radical procedure involving the removal of the lung, the pleura (lining of the lung), the pericardium surrounding the heart and part of the diaphragm. During surgery the pericardium and the diaphragm are reconstructed with a Gortex-like material. Patients may be eligible for this surgery only if they meet certain staging criteria and demonstrate adequate pulmonary and cardiac function to be able to tolerate the procedure.
