Surgical Management of Malignant Pleural Mesothelioma

Despite many years of clinical research, prognosis for malignant pleural mesothelioma remains poor. Due to the multicentric origin and the rapid local spread to vital thoracic structures the role of surgery is still controversial. At present surgery offers three options: pleurodesis, pleurectomy/decortication and extrapleural pneumonectomy. Pleurodesis is carried out as a palliative tool to arrest persistent pleural effusion in patients with advanced disease or poor general conditions. Pleurectomy/decortication is an effective symptom-relief but not-radical operation that imply preservation of the lung and is thus preferred in patients with poor residual lung function. Extrapleural pneumonectomy is the most aggressive procedure, which can be performed with acceptable morbidity and mortality in selected patients with good performance status and stage I or II. It represents an important step within a multimodality strategy, including chemo and radiotherapy, which has demonstrated to improve quality of life and survival.