The role of surgery in diagnosis and treatment of malignant pleural mesothelioma.
The role of surgery in the management of mesothelioma has largely been confined to obtaining a tissue diagnosis or to effect symptom control by pleurodesis. Noninvasive, image-guided methods of obtaining pleural tissue are reducing the need for surgical biopsy, and increased use of thoracoscopy under sedation by pulmonologist is also reducing surgical involvement. However, the increasing incidence of the disease together with reports of long-term survivors has resulted in a more aggressive surgical approach toward therapy. Surgical debulking may have a role in symptom control beyond that of pleurodesis. Radical surgery, with the aim of macroscopic clearance of the tumor, may not be of prognostic benefit alone but, as part of a multimodality treatment regime, may result in long-term survivors. Adjuvant treatments with chemotherapy and radiotherapy appear to prolong survival, whereas photodynamic therapy may be detrimental. Selection criteria for radical treatment need to be refined and a radical multimodality protocol must be subjected to a randomized, controlled evaluation.
Waller
David A
DA
Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK. debra.grew@uhl-tr.nhs.uk
D001706:Biopsy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D006801:Humans; D008654:Mesothelioma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging / Q000379:methods*; D010778:Photochemotherapy; D010997:Pleural Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D018700:Pleurodesis; D011379:Prognosis; D018714:Radiotherapy, Adjuvant