Extrapleural pneumonectomies for pleural mesothelioma

ABSTRACT

Introduction: Malignant pleural mesothelioma (MPM) is a fatal malignancy for which there is no definitive cure. The most effective multimodality treatment in prolonging survival is still matter of debate. Surgery remains one of the cornerstones in the multimodality therapy for MPM. Extra-pleural pneumonectomy and pleurectomy/decortication are the two main curative-intent procedures; however, the superiority of one technique over the other is still debated. This review aims to assess short- and long-term results of extrapleural pneumonectomy for MPM.

Areas covered: This article focuses on the role of extrapleural pneumonectomy in MPM. A systematic review was performed by using electronic databases to identify studies that included patients treated by this procedure for MPM. Endpoints included overall survival, disease-free survival, recurrence rate, perioperative mortality, and morbidity.

Expert commentary: This paper offers an overview of the results that are currently obtained in patients undergoing extrapleural pneumonectomy for MPM. The benefit of surgical treatments in MPM is still debated and its primary goal should be the achievement of a macroscopic complete resection. Several alternative multimodality protocols exist, with specific advantages and drawbacks; therefore, individualization of care for each patient is fundamental. The complexity of the surgical treatment mandates that patients be referred to specialized centers.

KEYWORDS:

• Extra-pleural pneumonectomy (EPP)
• malignant pleural mesothelioma (MPM)
• systematic review

Article highlights

• Malignant pleural mesothelioma has a poor prognosis.

• Overall, the literature suggests that EPP in conjunction with chemotherapy and radiotherapy may benefit selected patients affected by MPM, compared to palliative treatment only.

• It is still unclear which surgical technique for MPM (P/D vs EPP) is better in terms of survival and control of the disease.

• The type of surgery for MPM depends on clinical factors and on the expertise of individual surgeons but randomized trials and long-term results are necessary to assess the best approach.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.