Debunking the Myths About P/D
01-03-2011
By Worthington & Caron, P.C.
"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.