Pleurectomy is the most common surgery employed to manage patients with diffuse mesothelioma, and this procedure is associated with minimal postoperative morbidity and mortality.  Because mesothelioma usually recurs locally after surgery, efforts at optimizing local control have included both intraoperative phototherapy and chemotherapy.  However, neither of these techniques has demonstrated any significant benefit to date and thus should not be considered as standards of care.  No studies have compared pleurectomy to extrapleural pneumonectomy (EPP) in randomized trials.  However, nonrandomized series suggest a significant improvement in disease-free survival for those undergoing EPP versus pleurectomy.  Other data suggest that EPP may improve local control but may predispose the patient to distant metastases.  A randomized comparison of these techniques may be beneficial in identify the most effective procedure for patients with malignant diffuse mesothelioma.  (CHEST 1999; 116:446S-449S)

 (John R. Roberts, MD, FCCP)

Highlights of this article include:

• No studies have randomized similarly staged patients to pleurectomy or extrapleural pneumonectomy (EPP); thus the most effective surgery for patients with MPM has not been defined.

• Although no difference in overall survival between the two procedures, there was significant improvement in disease-free survival for those undergoing EPP compared with pleurectomy.

• Pleurectomy can be safely performed.  The addition of postoperative phototherapy or intrapleural chemotherapy does not improve long-term survival or result in symptom palliation.

• Limited data suggest that EPP may give greater chance of long-term survival in patients with favorable histology and earlier stage disease

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*** POSTED ON MAY 21, 2004   ***