Survival: Pleural Resection Vs Nonsurgical Management of Pleural Mesothelioma

For patients with pleural mesothelioma who are identified early in the course of disease, resection has historically been considered an important component of multimodal treatment. Over the past decade, surgical therapy has evolved substantially, with extra-pleural pneumonectomy being phased out due to high morbidity, and parenchymal sparing surgery (pleurectomy/decortication) being shown to have similar oncologic outcomes. Recently prospective data in the form of a randomized controlled trial has become available that calls the utility of pleurectomy into question. While an important and sorely needed piece of prospective data has been added to the body of literature, a lack of external validity limits the trial’s broad application to patients undergoing treatment. Based on existing data, those with early stage, epithelioid predominant disease should continue to be considered for resection at high volume referral centers, focusing on appropriate and aggressive pre-operative staging, with an eye toward the limitation of perioperative complications.