Mesothelioma Treatments: Palliative Surgery – Debulking Pleurectomy
A debulking pleurectomy is a surgical procedure that attempts to reduce the gross volume of malignant disease without attempting a complete resection of all cancerous tissue. It can be performed in addition to pleurodesis to better control fluid build-up and prevent the recurrence of pleural effusions and the symptoms associated with them. The reduction in tumor volume after a successful procedure may also have therapeutic benefits, but a debulking pleurectomy is only attempted to control the symptoms associated with the disease—it is not considered a curative approach to the treatment of pleural mesothelioma. When the procedure is performed in a curative manner it is considered radical surgery and is completed in combination with a decortication of the lung and full resection of the visceral pleura. To learn more about the use of pleurectomy-decortication for the curative treatment, please read our article: Mesothelioma Treatment: Curative Surgery – Pleurectomy-Decortication.
The goal of a debulking pleurectomy is a reduction in gross tumor volume through resection of the parietal pleura. The procedure is also referred to as a subtotal debulking parietal pleurectomy. The extent to which the surgeon will excise the entire parietal pleura, only part of it, or the full pleura along with some diseased tissue that extends beyond it will be determined at the time of surgery, where the surgeon’s decision will be based on overall tumor burden, patient health, performance status and expected recoverability.
Debulking pleurectomy has traditionally been completed through a thoracotomy, but contemporary treatment protocols call for the use of video-assisted thoracoscopic surgery (VATS) techniques. As is the case with many thoracoscopic procedures, VATS techniques have increased the efficacy of the surgery while reducing operative complications. A number of studies have found both survival and quality-of-life benefits to successful VATS pleurectomies.
Pleurectomy performed through thoracotomy is no longer recommended for most patients. Due to its association with significant post-operative complications, it is difficult to recommend this form of pleurectomy for palliative purposes.
Debulking Pleurectomy – Treatment Considerations
Debulking pleurectomy is a potentially beneficial palliative treatment for pleural mesothelioma patients who are not eligible for radical surgery, but a number of factors must be considered before a final decision can be rendered. The most important of these focuses on the type of procedure deployed for the surgery. As we said above, VATS procedures are more effective than ones performed through thoracotomy, but not all patients are eligible for VATS. A major problem for successful VATS procedures is scar tissue from previous thoracic surgeries, so patients who have had prior chest surgeries are less likely to be eligible for VATS. For these patients, thoracotomy may be the only option for a debulking pleurectomy, but this raises questions about treatment response and expected survivability in a palliative context. In this situation, the benefits to the symptom control expected from pleurectomy must be weighed against the hazards of a highly invasive procedure.
Another important consideration is overall patient health and stage. Patients who may candidates for surgeries with curative intent, such as radical pleurectomy-decortication or extrapleural pneumonectomy, will not undergo a debulking pleurectomy if their physician feels a better long-term outcome is possible with the radical surgeries. At the other end of the spectrum, patients with very advanced disease will only be treated for local symptom control and pain management, as more serious surgeries will not be an option for them.
A successful debulking pleurectomy can have significant benefits to patients with pleural mesothelioma, especially when performed in addition to pleurodesis. Treatment of pleural effusions and relief from the dyspnea associated with them are the primary endpoints of the procedure. While the reduction of tumor volume is not considered a curative approach to treatment, some studies have identified a survival benefit to patients who undergo debulking pleurectomy.
For more information related to surgical treatment, please read the following:
- Mesothelioma Treatment: Surgery
- Mesothelioma Treatment: Curative Surgery – Extrapleural Pneumonectomy
- Mesothelioma Treatment: Curative Surgery – Pleurectomy-Decortication
- Mesothelioma Treatment: Palliative Surgery – Decortication of the Lung
- Mesothelioma Treatment: Palliative Surgery – Pleurodesis
- Mesothelioma Treatment: Palliative Surgery – Pleural Catheters and Pleuroperitoneal Shunts
- Mesothelioma Treatment: Surgical Techniques – Thoracotomy
- Mesothelioma Treatment: Surgical Techniques – Video-Assisted Thoracoscopic Surgery (VATS)