Surgical Treatment of Diffuse Malignant Pleural Mesothelioma: a Review

Hillerdal G. Surgical Treatment Of Diffuse Malignant Pleural Mesothelioma: A Review.  Annals of Respiratory Medicine, February 2010; 1(1):79-84

Review Article

Gunnar Hillerdal
Affiliations: Department of Lung Diseases, Karolinska University Hospital

ABSTRACT

For more than 30 years, extrapleural pneumonectomy (EPP) has been practiced in suitable patients with diffuse malignant pleural mesothelioma. There has been a general feeling among many surgeons that this prolongs life. However, despite nearly 2000 published patients treated with EPP, no randomized study has ever been performed. This is most unfortunate with a potentially life‐threatening, invalidating, and very costly therapy in today’s era of evidence medicine. In published materials on PPE, the mean overall survival varies between 9 and 23 months; for almost as many in whom pleurectomy only was performed, it is 9–26 months. Patients subjected to EPP are very heavily selected, and this might explain the better outcome when compared with non‐surgical groups of patients. In fact, a recently published study showed an overall survival with chemotherapy only of 22 months in a subgroup filling the criteria usually used for EPP. Thus, it is high time to perform a randomized study to prove the efficiency of EPP.

Keywords: pleural mesothelioma, surgery, survival, review, randomized study
Correspondence: Gunnar Hillerdal, Department of Lung Diseases, Karolinska University Hospital, SE 171 76 Stockholm, Sweden. Tel: (+46)‐8‐3177000; Fax: (+46)‐8‐337998; e‐mail: gunnar.hillerdal@karolinska.se