title: Recommendations for uniform definitions of surgical techniques for malignant pleural mesothelioma: a consensus report of the international association for the study of lung cancer international staging committee and the international mesothelioma interest group.
abstract: BACKGROUND
  Extrapleural pneumonectomy has been well defined; however, surgeons vary regarding the surgical extent and goals of "pleurectomy/decortication" (P/D). We explored mesothelioma surgeons' concepts of P/D with the aim of unifying surgical nomenclature.
  
  
  METHODS
  A web-based survey was administered to surgeons who operated on malignant pleural mesothelioma (MPM) for diagnosis, staging, palliation, or cytoreduction. One hundred thirty surgeons from 59 medical centers were included. Surgeons who did not perform surgery for MPM within the last year were excluded.
  
  
  RESULTS
  There were 62 (48%) respondents from 39 medical centers in 14 countries. The mean number of patients with MPM seen annually at each medical center was 46, and the mean annual number of cytoreductive procedures performed per surgeon was 8. Most (88%) agreed that the goal of cytoreductive surgery should be macroscopic complete resection of tumor. P/D was defined as resection of parietal and visceral pleura with the aim of achieving macroscopic complete resection by 72% of respondents. If the diaphragm or pericardium required resection, 64% preferred the term "radical P/D," whereas "P/D" (40%) or "total pleurectomy" (39%) was preferred if these structures were not removed. Most surgeons believed that extrapleural pneumonectomy (90%) or "radical P/D" (68%) could provide adequate cytoreduction, whereas only 23% thought that P/D could.
  
  
  CONCLUSIONS
  There was significant variation regarding surgical nomenclature for procedures for MPM. The International Staging Committee of the International Association for the Study of Lung Cancer and the International Mesothelioma Interest Group recommend that P/D should aim to remove all macroscopic tumor involving the parietal and visceral pleura and should be termed "extended" P/D when the diaphragm or pericardium is resected.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. drice@mdanderson.org
authors.forename: David
authors.initials: D
authors.lastname: Rice
authors.forename: Valerie
authors.initials: V
authors.lastname: Rusch
authors.forename: Harvey
authors.initials: H
authors.lastname: Pass
authors.forename: Hisao
authors.initials: H
authors.lastname: Asamura
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakano
authors.forename: John
authors.initials: J
authors.lastname: Edwards
authors.forename: Dorothy J
authors.initials: DJ
authors.lastname: Giroux
authors.forename: Seiki
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Kemp H
authors.initials: KH
authors.lastname: Kernstine
authors.forename: David
authors.initials: D
authors.lastname: Waller
authors.forename: Ramon
authors.initials: R
authors.lastname: Rami-Porta
mesh_terms: D006801:Humans; D007390:International Agencies; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008654:Mesothelioma / Q000473:pathology* / Q000601:surgery*; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000473:pathology* / Q000601:surgery*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011639:Public Opinion; D019616:Thoracic Surgical Procedures