Surgical treatment of mesothelioma: Pleurectomy

Malignant diffuse mesothelioma is the most common type of mesothelioma, wit h a median survival ranging from 8.5 to 18 months after diagnosis. Good per formance status, absence of chest pain, age < 50 years, and epithelial hist ology are all associated with improved survival. Several investigators have described staging systems for this tumor and, have emphasized the importan ce of thoracoscopy in the diagnosis and staging of the disease. Pleurectomy is the most common surgery employed to manage patients with diffuse mesoth elioma, and this procedure is associated with minimal postoperative morbidi ty and mortality, Because mesothelioma usually recurs locally after surgery , efforts at optimizing local control have included both intraoperative pho totherapy and chemotherapy, However, neither of these techniques has demons trated any significant benefit to date and thus should not be considered as standards of care. No studies have compared pleurectomy to extrapleural pn eumonectomy (EPP) in randomized trials. However, nonrandomized series sugge st a significant improvement in disease-free survival for those undergoing EPP versus pleurectomy, Other data suggest th:at EPP may improve local cont rol but may predispose the patient to distant metastases. A randomized comp arison of these techniques may be beneficial in identifying the most effect ive procedure for patients with malignant diffuse mesothelioma.