Non-incisional pleurectomy-decortication for malignant pleural mesothelioma

Our plain-English summary of Non-incisional pleurectomy-decortication for malignant pleural mesothelioma, by F. Tanaka, N. Imanishi, M. Takenaka, et al (Surgery Today, 2018).

The study

• Authors: F. Tanaka, N. Imanishi, M. Takenaka, A. Taira
• Journal: Surgery Today
• Published: 2018;48(6):656-658
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pleurectomy-decortication (P/D) is lung-sparing surgery with curative intent for malignant pleural mesothelioma (MPM). Visceral pleurectomy is the most challenging step in this procedure. At the beginning of pleurectomy, a sharp pleural incision through the tumor is usually made to create the dissection plane between the visceral pleura and the lung parenchyma, which may cause the spread of tumor cells into the operation field. Here, we describe a sophisticated surgical technique of P/D without any pleural incision ("non-incisional P/D") to achieve en bloc removal of the entire pleura and tumor, which may improve postoperative survival by preventing tumor spread.

In plain English

This article, published as a "How to do it" surgical technique report, described a way of performing pleurectomy-decortication, a lung-sparing operation for malignant pleural mesothelioma, without first cutting into the pleura. The authors suggested that this cut, made through the tumor, may spread tumor cells. They illustrated the technique with one patient: a 64-year-old man in Japan with a history of occupational asbestos exposure. He had right-sided chest pain and fluid around the right lung, and a biopsy showed malignant pleural mesothelioma, judged clinical stage I. The surgeons removed the pleura, tumor and involved parts of the diaphragm, pericardium and lung in one piece without a pleural incision, leaving no visible tumor. Part of the middle lobe could not be peeled free because of tumor infiltration and was stapled off. Final pathology showed biphasic mesothelioma, pathologic stage III. The authors concluded that the technique may suit only carefully selected cases and that its real advantage over the usual incisional method still has to be investigated.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Surgical technique report ("How to do it") illustrated with a single case report
• Who was studied: One patient: a 64-year-old man treated at the Second Department of Surgery (Chest Surgery), University of Occupational and Environmental Health, Kitakyushu, Japan
• Exposure: A history of occupational asbestos exposure. No fiber type, job or dose was given. The article's subject was a surgical technique, not the exposure.
• Main results:
  • The patient achieved macroscopic complete resection (no visible tumor left) with non-incisional pleurectomy-decortication.
  • Part of the right middle lobe could not be decorticated because of tumor infiltration. That part was stapled and removed with the rest.
  • En bloc removal of the entire pleura, tumor and involved organs (diaphragm, pericardium and lung parenchyma) was completed without any pleural incision.
  • The final pathological diagnosis was biphasic malignant pleural mesothelioma with invasion of the pericardium and diaphragm (pathologic stage III). Before surgery it had been judged clinical stage I.
• The authors' conclusion: The authors concluded that non-incisional pleurectomy-decortication may be applied only in limited, carefully selected cases (an appropriately thickened pleura and minimal invasion of the lung). They said it should still be considered as lung-sparing surgery with curative intent.
• Limitations the authors state:
  • The authors stated that the true cancer-related advantage of non-incisional over incisional pleurectomy-decortication must still be investigated.
  • The authors stated that the technique may succeed only in carefully selected cases, such as one with an appropriately thickened pleura and minimal invasion of the lung.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleurectomy/Decortication (P/D), Pleural Mesothelioma, Visceral Pleura, Parenchyma, Pleura.

Related studies

• Extended pleurectomy decortication for thymoma with pleural dissemination — N. Imanishi, Y. Nabe, et al. (2019)
• Thoracic shaping technique to avoid residual space after extended pleurectomy/decortication — S. Bölükbas, M. Eberlein, et al. (2013)
• Non-incisional pleurectomy/decortication for malignant pleural mesothelioma — F. Tanaka, M. Takenaka, et al. (2021)
• Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma — S. Hasegawa (2014)
• Quality of life after radical pleurectomy decortication for malignant pleural mesothelioma — N.M. Mollberg, Y. Vigneswaran, et al. (2012)
• Current Treatment of Mesothelioma: Extrapleural Pneumonectomy Versus Pleurectomy/Decortication — A.S. Wolf, R.M. Flores (2016)

Browse more research in Surgery Today, or return to medical research.