Mesothelioma Surgical Care

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Surgical Care
http://emedicine.medscape.com/article/280367-treatment
Author: Winston W Tan, MD, Assistant Professor of Medicine, Mayo Medical School; Consulting Staff, Mayo Group Practices, Contributor Information and Disclosures

Surgical resection has been relied upon because radiation and chemotherapy have been ineffective primary treatments.25 The 2 surgical procedures used are pleurectomy with decortication and extrapleural pneumonectomy.

Pleurectomy with decortication is a more limited procedure and requires less cardiorespiratory reserve. It involves dissection of the parietal pleura, incision of the parietal pleura, and decortication of the visceral pleura followed by reconstruction. It has a morbidity rate of 25% and a mortality rate of 2%.26 It is a difficult procedure because the tumor encases the whole pleura; the local recurrence rate is high.

Extrapleural pneumonectomy is a more extensive procedure and has a higher mortality rate. Recently, the mortality rate has been lowered to 3.8%. It involves dissection of the parietal pleura; division of the pulmonary vessels; and en bloc resection of the lung, pleura, pericardium, and diaphragm followed by reconstruction. It provides the best local control because it removes the entire pleural sac along with the lung parenchyma.

With surgery alone, the recurrence rate is very high and most patients die after a few months. At least half the patients who have local control with surgery have distant metastasis upon autopsy.

In patients with epithelioid type, if fit to tolerate a thoracotomy, the best option is still a thoracotomy and macroscopic clearance of the tumor as part of multimodality therapy.

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