Extrapleural Pneumonectomy Is The Preferred Surgical Management In The Multimodality Therapy Of Pleural Mesothelioma: Con Argument
Published 2006 · Medicine
Malignant pleural mesothelioma (MPM) is an uncommon asbestos-related cancer with few good treatment options. Due to its low incidence/prevalence, frequent delay in diagnosis, and a strikingly short survival, few patients generally have been available for clinical trials. Because of a lack of therapeutic options, MPM historically has received little attention in many comprehensive cancer centers across the U.S. and throughout the world. In treatment centers that have specific programs for mesothelioma, treatment strategies often are remarkably different and based on considerable treatment biases. Recently, one of the surgical strategies that some centers have adopted is that of extrapleural pneumonectomy (EPP). Although the use of EPP in this disease has been enthusiastically embraced at a number of centers, it is superiority over a meticulous and complete radical pleurectomy and decortication (P/D) and even over non-operative treatment essentially remains unproven. In order to optimally and scientifically assess the place of EPP in the treatment armamentarium of MPM, this paper will review the theoretical and reported advantages of EPP compared to a lung-sparing approach such as P/D.