Surgery for mesothelioma? The debate continues

Abstract

There are few subjects more controversial among physicians who treat pleural mesothelioma than the role of surgery. Not only are there diverse opinions about the optimum surgical procedure, there is also fundamental disagreement about whether surgery has any place in the management of this disease. Most thoracic surgeons would agree, however, that for virtually all mesothelioma patients, a truly complete resection is not possible. Neither an extrapleural pneumonectomy (EPP) nor a radical pleurectomy/decortication (P/D) eradicates all residual microscopic tumour. Additional chemotherapy, radiation, or both is therefore often given. Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility studyIn view of the high morbidity associated with EPP in this trial and in other non-randomised studies a larger study is not feasible. These data, although limited, suggest that radical surgery in the form of EPP within trimodal therapy offers no benefit and possibly harms patients. Full-Text PDF Open Access