Despite many years of clinical research, there is still no effective therapy for malignant pleural mesothelioma (MPM.  Untreated, the prognosis is poor, with a median survival of <1 year.  Single-agent or combination chemotherapy as well as radiotherapy have not shown persistent improvements in response or survival.  In general, MPM is a disease confined to the pleura cavity for a long time before metastasizing.  Therefore, focus on local treatment seem rational.  Surgical resection has been considered the mainstay of treatment by some.  However, surgery alone results in high recurrence rates, and the survival benefit remains questionable.  In recent years, the emphasis has been on surgery combined with adjuvant therapies.  In this article, the present state of surgical management of MPM will be review  (CHEST 2003; 123:551-561)

( Serge van Ruth, MD; Paul baas, MD, PhD, FCCP; and Frans A. N. Zoetmulder, MD, PhD )

Highlights of this article include:

• Median Survival after Pleurectomy is 9 to 20 months.

• Median Survival with Extra-Pleural Pneumonectomy is 9 to 19 months.

• Compared with pleurectomy/decortication, a lower recurrence rate has been reported (10% after EPP vs 52% after pleurectomy)

• Relapses in distant sites are more frequently seen pleurectomy group.

• There does not seem to be a survival benefit for patients undergoing EPP in comparison to patients undergoing pleurectomy.

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*** POSTED ON MAY 21, 2004   ***