Pleuropneumonectomy in the Treatment of Malignant Pleural Mesothelioma

Malignant pleural mesothelioma (MPM)is predominantly a local/regional disease that results in a survivaltime that ranges from 4 to 12 months without treatment. Single-modalitytherapy using surgery, chemotherapy, or radiotherapy alone is largelyineffective. The objective of the study was presentation of the use ofpleuropneumonectomy in a multimodality treatment setting and theresults. Didactic presentation. Academic tertiary-care hospital. One hundred eighty-three patients who underwentmultimodality therapy. Of all thesingle-modality treatment approaches, pleuropneumonectomy has beenassociated most consistently with long-term disease-free survival andhas provided the greatest amount of tumor cytoreduction. The techniqueof pleuropneumonectomy traditionally has been linked with highperioperative mortality and morbidity when compared with that of othercytoreductive techniques such as pleurectomy/decortication. Recently, improvements in operative mortality (< 5%) have been reported, largely due to improvements in patient selection and perioperativemanagement. Multimodality therapy, including chemotherapy, radiotherapy, and extrapleural pneumonectomy, was used to treatpatients. Outcomes were presented for 183patients with MPM who underwent multimodality therapy. With the development of multimodality therapy, pleuropneumonectomy followed by sequential chemotherapy andradiotherapy has demonstrated a significant survival benefit, especially for patients who have epithelial tumor histology, tumor-freeresection margins, and tumor-free extrapleural nodestatus.