Extrapleural pneumonectomy and extended pleurectomy/decortication for malignant pleural mesothelioma: the Memorial Sloan-Kettering Cancer Center approach.

Surgical management for malignant pleural mesothelioma (MPM) remains controversial, but because of the limitations of radiation and chemotherapy in this disease, surgery is still an important part of treatment for these patients (1-13). Operations for MPM can be categorized as those performed with either palliative or curative intent. Palliative procedures such as video-assisted thoracoscopy surgery (VATS) and talc pleurodesis control pleural effusions in patients whose overall medical condition precludes definitive resection (14). In such cases, thoracotomy and partial pleurectomy is indicated only when the pleural effusion is loculated and cannot be evacuated by VATS. Curative intent operations include extrapleural pneumonectomy (EPP) and extended pleurectomy/decortication (P/D). This article provides a brief review of preoperative evaluation and the surgical technique for EPP and P/D (15-17).