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Extended pleurectomy decortication: the current role.
Rocco Bilancia1, Marco Nardini2, David A Waller3
1Department of Thoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK.
Translational Lung Cancer Research
|November 20, 2018
Summary
Extended pleurectomy/decortication (EPD) is a viable alternative to extrapleural pneumonectomy for mesothelioma surgery. However, its use requires careful patient selection due to varying evidence and ongoing trials comparing it to less invasive options.
Area of Science:
- Thoracic surgery
- Surgical oncology
- Malignant pleural mesothelioma treatment
Background:
- Extended pleurectomy/decortication (EPD) is a complex surgical procedure for malignant pleural mesothelioma.
- Technical aspects of EPD are debated among specialists due to its rarity and concentration in specialized centers.
- EPD is increasingly accepted as an alternative to extrapleural pneumonectomy, preserving lung function.
Purpose of the Study:
- To discuss the indications and considerations for extended pleurectomy/decortication in mesothelioma surgery.
- To evaluate the role of EPD in comparison to less radical and non-surgical treatments.
- To highlight the ongoing research and clinical dilemmas surrounding EPD.
Main Methods:
- Review of current surgical practices and literature regarding extended pleurectomy/decortication.
- Discussion of comparative effectiveness with extrapleural pneumonectomy and video-assisted partial pleurectomy.
- Consideration of evidence from randomized controlled trials, including MARS2.
Main Results:
- Extended pleurectomy/decortication is a favorable alternative to extrapleural pneumonectomy for selected patients.
- Video-assisted partial pleurectomy may be preferable for patients with poorer prognostic factors, though evidence shows no survival benefit over talc pleurodesis.
- The definitive role of EPD is pending results from ongoing trials comparing surgical and non-surgical management.
Conclusions:
- Extended pleurectomy/decortication offers a lung-sparing approach for mesothelioma but requires careful patient selection.
- Clinical decisions regarding EPD are complicated by limited high-grade evidence and the need for further research.
- The future utility of EPD may be influenced by its comparison with non-surgical treatments in upcoming studies.
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