Extrapleural Pneumonectomy Mesothelioma Surgery
Extrapleural pneumonectomy is a complex form of mesothelioma surgery that can provide the best prognosis for certain patients with pleural mesothelioma. In this type of mesothelioma surgery, the entire diseased lung is removed, along with the pleura that lines the chest wall, the pleura that covers the lung, the sac around the heart, a substantial section of the diaphragm and part of the nerve that controls its movement.
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This Form of Mesothelioma Surgery Requires Careful Candidate Selection
While there is still a great deal of debate as to what the criteria should be in selecting candidates for extrapleural pneumonectomy, it is generally believed that the best candidates are those whose disease is still in the earliest stages. Even though pleural mesothelioma is diffuse (meaning it surrounds organs as opposed to forming as a single mass), in the early stages it is still contained in a comparatively small region. This makes mesothelioma surgery more effective.
Patients diagnosed with the epithelioid form of mesothelioma also have a good outcome. The epithelioid cells are shaped like elongated tubes and are relatively uniform in shape with a distinct nucleus. The other two cell types – sarcomatoid, oval in shape, but not uniform and without a clear nucleus, and biphasic, which means both epithelioid and sarcomatoid cells are present – have a poorer prognosis.
Who Benefits from This Mesothelioma Surgery?
Studies have shown that survival after extrapleural pneumonectomy mesothelioma surgery can range from 9.4 to 27.5 months, with 1-year survival rates from 36 to 83 percent, 2-year survival rates from 5 to 59 percent, and 5-year survival rates from 0 to 24 percent. Mortality rates during surgery ranged from 0 to 11.8 percent, and the rates of medical conditions resulting from surgery ranged from 22 to 82 percent.
Prognosis for Extrapleural Pneumonectomy
Researchers have noted that patients who have undergone extrapleural pneumonectomy fare even better with the addition of chemotherapy and radiation administered after the surgery.
n a study titled "Outcomes After Extrapleural Pneumonectomy and Intensity-Modulated Radiation Therapy for Malignant Pleural Mesothelioma", in The Annals of Thoracic Surgery, researchers from the H. Lee Moffitt Cancer Center in Tampa teamed up with researchers from other institutions to determine if intensity-modulated radiation therapy (IMRT) administered after mesothelioma surgery would reduce recurrence in the area where the tumor originated.
They found that among the 63 patients who received IMRT, average overall survival was 14.2 months. Distant recurrences of the disease occurred in 33 of the 61 patients who could be evaluated. Eight patients had recurrence, either in the area near the tumor site or nearby; and five of the eight also had distant recurrences. Only three patients had recurrence within the irradiated field.
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