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.
