Current surgical strategies for malignant pleural mesothelioma

Surg Today. 2016 Aug;46(8):887-94. doi: 10.1007/s00595-015-1275-3. Epub 2015 Nov 21.

Abstract

Malignant pleural mesothelioma (MPM) is associated with a poor prognosis. The main components of multimodality treatment include surgery, chemotherapy, and radiation therapy. Surgery remains controversial. Two procedures are currently offered: extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). The recent scientific literature suggests that P/D is a well-tolerated procedure, with the potential of becoming a default procedure in multimodality regimens. However, the precise treatment schemes and surgical procedures are yet to be established. In our study, we review the advantages and disadvantages of EPP and P/D, summarize the post-EPP and post-P/D observations (including mortality, morbidity, and median survival time), and discuss the choice of surgical technique (EPP vs. P/D). Moreover, we highlight the aspects of the multimodality treatments that are offered to MPM patients, including chemotherapy, radiotherapy, intensity-modulated radiation therapy, and other types of therapy.

Keywords: Extrapleural pneumonectomy; Malignant pleural mesothelioma; Pleurectomy/decortication; Surgical therapy.

Publication types

  • Review

MeSH terms

  • Combined Modality Therapy
  • Humans
  • Induction Chemotherapy
  • Lung Neoplasms / pathology
  • Lung Neoplasms / surgery*
  • Mesothelioma / pathology
  • Mesothelioma / surgery*
  • Mesothelioma, Malignant
  • Neoplasm Staging
  • Pleura / surgery*
  • Pleural Neoplasms / pathology
  • Pleural Neoplasms / surgery*
  • Pneumonectomy / methods*
  • Pneumonectomy / trends*
  • Radiotherapy, Intensity-Modulated
  • Thoracic Surgical Procedures / methods*
  • Thoracic Surgical Procedures / trends*