Pleuropneumonectomy in the treatment of malignant pleural mesothelioma

Study objectives: Malignant pleural mesothelioma (MPM) is predominantly a l ocal/regional disease that results in a survival time that ranges from 4 to 12 months without treatment. Single-modality therapy using surgery, chemot herapy, or radiotherapy alone is largely ineffective. The objective of the study was presentation of the use of pleuropneumonectomy in a multimodality treatment setting and the results. Design: Didactic presentation. Setting: Academic tertiary-care hospital. Patients: One hundred eighty-three patients who underwent multimodality the rapy. Interventions: Of all the single-modality treatment approaches, pleuropneum onectomy has been associated most consistently with long-term disease-free survival and has provided the greatest amount of tumor cytoreduction. The t echnique of pleuropneumonectomy traditionally has been linked with high per ioperative mortality and morbidity when compared with that of other cytored uctive techniques such as pleurectomy/decortication. Recently, improvements in operative mortality (< 5%) have been reported, largely due to improveme nts in patient selection and perioperative management. Multimodality therap y, including chemotherapy, radiotherapy, and extrapleural pneumonectomy, wa s used to treat patients. Results: Outcomes were presented for 183 patients with MPM who underwent mu ltimodality therapy, Conclusions: With the development of multimodality therapy, pleuropneumonec tomy followed by sequential chemotherapy and radiotherapy has demonstrated a significant survival benefit, especially for patients who have epithelial tumor histology, tumor free resection margins, and tumor-free extrapleural node status.