Surgery Approaches in Mesothelioma

Abstract

The role of surgical resection in malignant pleural mesothelioma (MPM) is controversial, but cancer-directed surgery has yielded long-term survivors and demonstrated 15% 5-year survival. The two operations developed for surgical resection, extrapleural pneumonectomy (EPP), and radical or extended pleurectomy/decortication (P/D) are described. In addition, this chapter summarizes the preoperative, perioperative, and postoperative management of these patients and the results of studies evaluating both procedures. Data and clinical experience suggest that P/D is better tolerated by patients, and evidence suggests survival is not worse. Although EPP is still performed in selected cases, the authors advocate radical P/D for most patients with MPM.