Mesothelioma Cancer

Treatment options for malignant mesothelioma

Surgical procedures

Pleurectomy

Pleurectomy is a technique to remove the parietal pleura from the lung. The chest wall is opened on the side of the tumor by making a cut at the back and side of the chest. A rib may be removed to help the surgeon gain access to the affected lung. The parietal pleura is then stripped from the top of the lung down to the bottom. Large tubes are inserted between the ribs to drain blood and manage any air leaks from the lungs; these are usually left in place for around 5-6 days.

Pleurectomy is not without risks. About 2% of patients die during surgery, and there are a number of complications that may occur, including:

• Bronchopleural fistula (development of an abnormal connection between the breathing tubes and the pleura, allowing air to leak out from the lungs).
• Massive bleeding.
• Subcutaneous emphysema (an air leak from the lungs into the overlying tissues, under the skin).
• Pneumonia.
• Incomplete tumor removal (resulting in local recurrence).
• Breathing difficulties.

The median survival after pleurectomy for malignant mesothelioma ranges from 6-21 months, and 9-40% of patients survive to 2 years. These wide ranges are reported in trials by different research groups using various treatment combinations (surgery performed with or without radiation therapy or chemotherapy). Patients should seek information about the experience and results at the facility where they are being treated.

Pleurectomy is only considered if the normal space between the parietal and visceral pleurae remains, and the two layers of the pleura have not fused together. In cases where the pleural layers have fused, stripping would also involve removal of underlying lung tissue (decortication). This is difficult in malignant mesothelioma, because a clear plane between the tumor and lung is hard to define, so that stripping the lung would damage it. In cases where the tumor has caused such fusion, an extrapleural pneumonectomy would usually be more appropriate.