Lung Sparing Surgery for Malignant Pleural Mesothelioma

Malignant pleural mesothelioma is a diffuse tumor that does not easily lend itself to surgical resection. However, there are several observations that seemingly support the use of surgery in this disease. A variety of surgical procedures have been utilized in an attempt to provide the maximum therapeutic benefit to patients with malignant pleural mesothelioma. They vary from a small thorascopic pleurodesis procedure to a radical extrapleural pneumonectomy. Pleurectomy/decortication (P/D) and partial pleurectomy, have been used in many centers as an alternative procedure in patients who cannot undergo extrapleural pneumonectomy (EPP). Mortality of partial pleurectomy and P/D ranges between 0% and 8%. Survival statistics showed a slight trend for longer disease-free survival in extended P/D versus P/D, but there were no differences in median overall survival. Partial pleurectomy appeared to be inferior, with an overall median survival ranging from 7.1 to 14 months. Overall, current evidence supports the claim that P/D produces similar or better outcomes than EPP. The results of the Mesothelioma And Radical Surgery 2 trial will hopefully provide a stronger evidence on these topics.

Keywords: Extrapleural pneumonectomy, pleurectomy/decortication, partial pleuroectomy.