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Pleurectomy - Mesothelioma surgery
Pleurectomy is one of the surgical methods for mesothelioma treatment.
This kind of treatment is aimed at preserving the normal lung parenchyma from the affection of the tumor and at the reduction of the tumor scale. The specimen for the surgery includes parietal pleura and visceral pleura, it also may include (but not obligatory) a pericardial or diaphragmatic portion. General anesthesia is required for this operation along with the ventilation of one lung.
Firstly the patient takes the required lateral decubitus position. After careful dissection of all large tumors going with the lung preservation, the posterolateral thoracotomy is carried out.
Pleurectomy/decortication is the operation of the pleura removal. Pleura and pericardium are essentially stripped from the lung apex down to the diaphragm, not affecting the entire lung. Pleural fluid is best locally controlled by this procedure. This kind of surgery has lower than 3% death rate, which is lower than EPP. The recurrence rate of pleural effusion that goes with mesothelioma is lower with pleurectomy than with talc pleurodesis.
The patients managing generally their disease and having a good lung expansion are subjected best to Pleurecomy. It can be used in patients who have also suffered the fluid buildup happening rapidly and in symptomatic way. This method of the treatment may also be found more successful for the patients with later stages of the mesothelioma unlike EPP, which is more risky and radical; moreover Pleurectomy can be used on older mesothelioma patients.
This method of the treatment, as well as others applied to mesothelioma patients, does not show the definite possibility to prolong their lives when used alone. Though, its combination with radiation has shown the promising result during the recent research when 41% of the group of 27 patients with mesothelioma of the epithelial subtype has reached the survival rate up to 22 months and 2 years.
There are many factors, such as the stage of the tumor, that affect the final decision of the type of recommended surgery. The size of the tumor prior to surgery has become the reliable predictor of the general survival and surgical outcome during at least one study. The average survival rate of the patients with the tumor less than 100 cubic centimeters who were treated with surgery is 22 months, which is twice as long as of the patients with the tumor size exceeding 100 cc., with 11 months respectively.
Pleural effusions can be controlled effectively through open pleurectomy and decortication, though these methos are invasive and lead to high mortality (approx. 30%) and morbidity during the surgery, so that their usage is reasonable only in complicated cases. Nevertheless, nowadays the majority of thoracic surgical centers can afford VATS (video-assisted thoracic surgery).
This is an effective technique that shows very low morbidity and mortality rate (approximately 1.5%) while performing partial pleurectomy extending up to cytoreductive surgery. It also considerably decreases the recurrence rate in cases that have earlier been resistant to other treatment procedures. This kind of treatment, being the matter of choice, still requires improvement and is to be used in randomized trial.
It is important for mesothelioma patients to study carefully all the options, as far as there has not been figured out any certain advantages of one procedure over another. Moreover, surgical treatment has not been proved to have definite advantages over non-surgical methods.
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