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Debunking the Myths About P/D

"The Question is, Why Wouldn't a Patient Choose P/D?"

In 1994, Dr. Robert B. Cameron began to develop his specific "radical" lung-sparing pleurectomy and decortication (P/D) surgical procedure as a more rational and less radical alternative to the popular radical extra-pleural pneumonectomy (EPP) surgical procedure for malignant pleural mesothelioma (MPM).

The data show that P/D is much safer than EPP. Surgical mortality (that is, when the patient dies during surgery) for P/D is only 3-4%. For EPP, surgical mortality is 5-7%, or almost twice as high. On top of fatalities, another two-thirds of EPP patients encounter serious surgical complications. Dr. Cameron’s surgical mortality numbers are below 1%.

P/D patients retain the use of both lungs, affording them a better quality of life. EPP patients are left with only one lung. With only on lung, the patient is vulnerable to threats to the remaining lung like infection, pneumonia or pulmonary restriction from prior smoking, asbestos scarring or the unshakeable threat of mesothelioma recurrence.

The only randomized trial for EPP (where the surgeon cannot bias the results through patient selection), revealed that patients who had EPP in fact did worsethan patients who avoided surgery altogether. Studies which have looked at both EPP and P/D reveal that P/D patients survive longer.

With P/D’s superiority overwhelmingly confirmed, the question is then, why wouldn't a patient choose a P/D over EPP? It seems that those clinging to the out-dated notion of performing EPP have tried to answer this question with a series of “myths” about P/D.

Over the coming weeks, Dr. Cameron, as the innovator of the P/D and the surgeon most experienced in performing it, will address in turn each of these "myths".

MYTH #1: “P/D Is Only Appropriate For Very Early Stage Meso.” January 3, 2011

Proponents of the EPP have been known to suggest that “P/D is fine for early-stage cases, but for a BIG tumor you need a BIG surgery.”

It is certainly true that lung-sparing P/D is more appropriate for early-stage cases than EPP. For a patient who is younger with less invasive tumor and a good long-term survival prognosis, there is simply no compelling reason to endure the risks and compromised quality of life associated with a radical lung amputation/EPP.

But just because P/D is more appropriate for early-stage patients does not mean that radical EPP is better for more advanced patients. Statistics reveal that P/D is also better advanced cases of pleural mesothelioma. In fact, many of those who argue that P/D is only appropriate for early-stage meso WILL NOT actually perform EPP for late-stage meso. They understand that EPP is too radical and difficult for late-stage patients and don’t want to harm their published survival statistics. They route their late-stage patients to P/D instead.

As a result, most studies comparing P/D to EPP show patients who were younger (less than 60) and relatively healthy going to EPP, and patients who were older (70 or above) and with more sickness going to P/D. Yet the overall survival for older, more advanced patients who had P/D was still BETTER than the survival for younger, less advanced patients who had EPP.

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