All of the standard approaches to treating solid tumors—radiation,
chemotherapy, and surgery—have been investigated in patients with
malignant pleural mesothelioma. Although surgery, by itself, is not very
effective, surgery combined with adjuvant chemotherapy and radiation
(trimodality therapy) has produced significant survival extension (3–14
years) among patients with favorable prognostic factors.
[38]
However, other large series of examining multimodality treatment have
only demonstrated modest improvement in survival (median survival 14.5
months and only 29.6% surviving 2 years).
[32]
Reducing the bulk of the tumor with cytoreductive surgery is key to
extending survival. Two surgeries have been developed: extrapleural
pneumonectomy and pleurectomy/decortication. The indications for
performing these operations are unique. The choice of operation depends
on the size of the patient's tumor. This is an important consideration
because tumor volume has been identified as a prognostic factor in
mesothelioma.
[39]
Pleurectomy/decortication spares the underlying lung and is performed
in patients with early stage disease when the intention is to remove all
gross visible tumor (macroscopic complete resection), not simply
palliation.
[40]
Extrapleural pneumonectomy is a more extensive operation that involves
resection of the parietal and visceral pleurae, underlying lung,
ipsilateral diaphragm, and ipsilateral pericardium. This operation is
indicated for a subset of patients with more advanced tumors, who can
tolerate a pneumonectomy.
[41]
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