Pleurectomy and decortication (P/D) improve survival and quality of life in selected patients with malignant pleural mesothelioma. The operative procedure was not standardized until recently. The goal of the operation is to perform a macroscopic complete resection of the tumor. This often involves resection of the parietal and visceral pleura and invariably a partial or complete resection and prosthetic reconstruction of ipsilateral hemidiaphragm. We describe our operative planning and technique as well as outcomes of P/D reported in current literature.
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http://dx.doi.org/10.21037/atm.2017.04.03 | DOI Listing |
Eur J Surg Oncol
January 2025
Department of Surgery, Clinique de Genolier, Genolier, Switzerland. Electronic address:
Cytoreductive surgery remains controversial in pleural mesothelioma. The MARS2 trial suggested that extended pleurectomy decortication following neoadjuvant chemotherapy was associated with no survival benefit, more serious adverse events and poorer quality of life than systemic chemotherapy alone in patients with resectable pleural mesothelioma. However, patient selection, chemotherapy scheme, high surgical mortality (9 %) and poor outcomes in the surgical cohort have been raised by mesothelioma experts as potential issues in MARS2.
View Article and Find Full Text PDFAnn Surg
January 2025
The Thoracic Surgery Oncology laboratory and the International Mesothelioma Program (www.impmeso.org), Division of Thoracic Surgery and the Lung Center, Brigham, and Women's Hospital, and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Objective: We hypothesize that recurrence following pleurectomy decortication (PD) is primarily local. We explored factors associated with tumor recurrence patterns, disease-free interval (DFI), and post-recurrence survival (PRS).
Summary Background Data: Tumor recurrence is a major barrier for long-term survival after pleural mesothelioma (PM) surgery.
Ann Thorac Surg Short Rep
December 2024
Thoracic Surgery Department, Nottingham University Hospitals NHS Trust, UK.
Gorham-Scout disease (GSD) is a rare skeletal disorder of unknown etiology characterized by progressive osteolysis and excessive lymphovascular proliferation. Chylothorax is a life-threatening complication. A teenager presented with a left pleural effusion on a background of chronic flank collection secondary to lymphovascular malformation.
View Article and Find Full Text PDFAnn Thorac Surg Short Rep
December 2024
Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Background: In malignant pleural mesothelioma), it is difficult to evaluate the degree of tumor progression using imaging findings. It is essential to develop an objective index that is independent of imaging findings and useful for assessing the degree of tumor progression and indications for surgery.
Methods: We retrospectively evaluated the data of 79 patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy or pleurectomy/decortication at our institution between 1999 and 2022.
J Thorac Oncol
January 2025
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York. Electronic address:
Introduction: The phase 3 randomized controlled trial of extended pleurectomy decortication and chemotherapy versus chemotherapy alone for pleural mesothelioma (PM) (MARS2) reported "extended pleurectomy decortication was associated with worse survival to 2 years, and more serious adverse events for individuals with resectable PM, compared with chemotherapy alone." These results have led to considerable discourse regarding the future role of surgery for PM, and there has not been unanimity in the mesothelioma surgical community regarding the trial interpretation. This "perspective" evaluates MARS2 using internationally renowned PM experts who either agreed with the trial interpretation or who found issues with its conduct which may have influenced the results.
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