Pleurectomy/decortication for palliation in malignant pleural mesothelioma: results of surgery

Our plain-English summary of Pleurectomy/decortication for palliation in malignant pleural mesothelioma: results of surgery, by O. Soysal, N. Karaoğlanoğlu, S. Demiracan, et al (European Journal of Cardio-thoracic Surgery, 1997).

The study

• Authors: O. Soysal, N. Karaoğlanoğlu, S. Demiracan, S. Topçu, I. Taştepe, S. Kaya, M. Unlü, G. Cetin
• Journal: European Journal of Cardio-thoracic Surgery
• Published: 1997;11(2):210-3
• Cited by: 52 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Surgery can only offer palliation in an attempt to slow the progression of malignant pleural mesothelioma (MPM). We want to assess the effectiveness and safety of pleurectomy/decortication in establishing a tissue diagnosis, and controlling pleural fluid accumulation and symptoms in patients with MPM.

Methods: We reviewed our pleurectomy results in 100 patients with MPM over a 19 year period. Major symptoms were chest pain, cough and dyspnea, and radiographic findings included pleural mass, pleural fluid and constriction of involved hemithorax.

Results: Approximately two thirds of the patients underwent surgery prior to tissue diagnosis. Eighty-nine patients had stage I and stage II disease, 8 and 81%, respectively. The patients underwent subtotal (44%) or total pleurectomy (56%). The surgical mortality rate was 1% (1/100) and the morbidity rate was 22%. Morbidity included prolonged air leak (n = 12), empyema (n = 6), reaccumulation of pleural fluid (n = 2) and wound infection (n = 2). Palliative results included dyspnea and cough relief in all patients, chest relief in 60 (85%) and pleural fluid control in 52 (96%) patients. Median survival was 17 months in MPM patients.

Conclusions: We conclude that pleurectomy/decortication safely provides both tissue diagnosis and effective of pleural effusion and symptoms and therefore excellent palliation in patients with MPM.

In plain English

This was a review of 100 patients with malignant pleural mesothelioma who had surgery at a chest surgery center in Ankara, Turkey, between 1974 and 1992. Their average age was 41 (range 12 to 70). 74% had a history of asbestos exposure or had lived in asbestos or erionite areas of Turkey. Surgeons removed the pleura (the lining of the lung and chest wall) to relieve symptoms. Removal was complete in 56 patients and partial in 44. For 68 patients, a tissue diagnosis was made only after the chest was opened. One patient died after surgery (1%), and 22% had complications, most often a prolonged air leak (12 patients). Among patients with each symptom before surgery, the authors reported relief of cough in all 40, breathlessness in all 37, and chest pain in 60 of 71 (85%). Fluid built up again in 2 of 100 patients. Median survival was 17 months (range 3 to 63). The authors concluded that the operation safely gave a tissue diagnosis and "excellent palliation," but said that without a controlled study it could not be determined whether it prolongs survival.

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: Retrospective review (case series) of patients operated on at one center; no comparison group
• Who was studied: 100 patients with malignant pleural mesothelioma who underwent surgery at the Atatürk Chest Diseases and Thoracic Surgery Center, Ankara, Turkey, 1974 to 1992. The female to male ratio was 1:5 and the average age was 41 (range 12 to 70). Eight earlier patients who had pleural pneumonectomy were excluded.
• Exposure: 74% of patients had a history of asbestos exposure or had lived in asbestos or erionite areas of Turkey. The authors describe villagers using asbestos-contaminated 'white soil' for whitewashing houses. No fiber types or doses were measured. The treatment studied was pleurectomy/decortication.
• Main results:
  • Complete pleurectomy/decortication was done in 56% of patients. The other 44 had subtotal pleurectomy.
  • 68 of the 100 patients received their tissue diagnosis only after thoracotomy.
  • Surgical mortality was 1% (one patient, after empyema, sepsis and ARDS).
  • Overall morbidity was 22%. This included prolonged air leak in 12 patients, empyema in 6, reaccumulation of pleural fluid in 2 and wound infection in 2.
  • Among patients who had each symptom before surgery, dyspnea was relieved in all 37 and cough in all 40. Chest pain was relieved in 60 of the 71 patients with chest pain (85%).
  • Pleural fluid was controlled in 52 patients (96%), counted among those who had pleural fluid before surgery (54 in Table 1). Pleural fluid reaccumulated in 2 of 100 patients (2%).
  • Cell types were epithelial in 60 patients, sarcomatous in 11 and mixed in 29.
  • Tumor recurred at the thoracotomy site or chest tube tracks in two patients.
  • Median survival of the patients was 17 months (range 3 to 63 months).
  • Patients who also received radiation therapy and/or chemotherapy had a survival of 22 months. No statistical comparison was reported.
• The authors' conclusion: The authors concluded that pleurectomy/decortication safely provides a tissue diagnosis and effective control of pleural effusion and symptoms, and therefore what they called excellent palliation, in patients with malignant pleural mesothelioma.
• Limitations the authors state:
  • Without a controlled study, the authors could not determine whether the operation prolongs survival.
  • A chest CT scan, which the authors call the most useful diagnostic test, was obtained in only 23 patients.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleurectomy/Decortication (P/D), Pleural Mesothelioma, Dyspnea, Hemithorax, Empyema, Palliative Care, Median Survival, Pleural Effusion.

Related studies

• Extended Pleurectomy and Decortication for Malignant Pleural Mesothelioma Is an Effective and Safe Cytoreductive Surgery in the Elderly — T. Williams, H. Duraid, et al. (2015)
• Is pleurectomy and decortication superior to palliative care in the treatment of malignant pleural mesothelioma? — I. Zahid, S. Sharif, et al. (2011)
• Extrapleural Pneumonectomy Versus Pleurectomy/Decortication for Malignant Pleural Mesothelioma — N. Zhou, D.C. Rice, et al. (2022)
• Clinical Outcomes With Recurrence After Pleurectomy/Decortication for Malignant Pleural Mesothelioma — A. Nakamura, T. Takuwa, et al. (2020)
• Prognostic factors for survival after surgical palliation of malignant pleural effusion — J.E. Pilling, M.E. Dusmet, et al. (2010)
• Mesothelioma--VATS biopsy and lung mobilization improves diagnosis and palliation — M.W. Grossebner, A.A. Arifi, et al. (1999)

Browse more research in European Journal of Cardio-thoracic Surgery, or return to medical research.