Surgery for malignant pleural mesothelioma: an international guidelines review

Abstract

Currently there is no universally accepted surgical therapy for malignant pleural mesothelioma (MPM). The goal of surgery in this dismal disease is a macroscopic complete resection (MCR) and there are two types of intervention with a curative intent. At one side, there is the extrapleural pneumonectomy (EPP) which consists in an en-bloc resection of the lung, pleura, pericardium and diaphragm and at the other side, there is pleurectomy/decortication (P/D) a lung-sparing surgery. Initially, EPP was considered the only surgical option with a curative aim, but during the decades P/D have acquired a role of increasing importance in MPM therapy. Several randomized prospective trials are required to establish the best strategy in the treatment of pleural mesothelioma. Although which is the best surgical option remains unclear, the International Mesothelioma Interest Group (IMIG), recently have stated that the type of surgery depends on clinical factors and on individual surgical judgment and expertise. Moreover, according to the current evidence, the surgery should be performed in high-volume centres within multimodality protocols. The aim of this study is to examine the currently available international guidelines in the surgical diagnosis and treatment of MPM.

Biomarkers for Malignant Pleural Mesothelioma—A Novel View on Inflammation

“…Patients face a devastating prognosis of 12 months median survival only after diagnosis [1]. Despite recent-and, in part, promising-developments regarding both systemic therapy and cytoreductive surgery, MPM remains a clinical challenge, especially when it comes to treatment allocation [2,3]. Furthermore, the optimal (multimodal) treatment regimens still remain to be defined from the available arsenal of immune therapy, surgery, radiation and systemic treatment [4].…”

<p>Pain management in patients with malignant mesothelioma: challenges and solutions</p>

“…Palliative debulking surgery and parietal pleurectomy are performed to provide symptom control in MPM. This type of surgery is not undertaken with a curative intent but removal of the visceral pleura, and relieve of a trapped lung can, reduce chest wall pain 50. Video-Assisted Thoracic Surgery (VATS) offers a minimally invasive alternative for patients who are unfit for radical EPP or extended P/D.…”

Tumor‐associated macrophage‐derived inflammatory cytokine enhances malignant potential of malignant pleural mesothelioma

“…Epidemiological studies have proven that occupational or environmental exposure to asbestos is involved in the development of MPM and the incidence of MPM is predicted to continue increasing. Multimodal therapy including surgical treatments such as extrapleural pneumonectomy and pleurectomy/decortication is applicable only to patients with early‐stage disease and good performance status 1 . Systemic chemotherapy with cisplatin and pemetrexed is the only approved regimen with the evidence to prolong overall survival of inoperable patients, but the median overall survival time of patients who are treated with this regimen is 12 mo after diagnosis 2,3 .…”

“…Multimodal therapy including surgical treatments such as extrapleural pneumonectomy and pleurectomy/decortication is applicable only to patients with early-stage disease and good performance status. 1 Systemic chemotherapy with cisplatin and pemetrexed is the only approved regimen with the evidence to prolong overall survival of inoperable patients, but the median overall survival time of patients who are treated with this regimen is 12 mo after diagnosis. 2,3 Although recent clinical phase II studies demonstrated that nivolumab, an anti-programmed death-1 (PD-1) antibody, showed promising clinical activity in patients with relapsed MPM, there has been a lack of definitive evidence to support the practical use of nivolumab to improve the prognosis.…”