Pleurectomy/decortication for palliation in malignant pleural mesothelioma: results of surgery

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Abstract
OBJECTIVE: Surgery can only offer palliation in an attempt to slow theprogression of malignant pleural mesothelioma (MPM). We want to assess theeffectiveness and safety of pleurectomy/decortication in establishing atissue diagnosis, and controlling pleural fluid accumulation and symptomsin patients with MPM. METHODS: We reviewed our pleurectomy results in 100patients with MPM over a 19 year period. Major symptoms were chest pain,cough and dyspnea, and radiographic findings included pleural mass, pleuralfluid and constriction of involved hemithorax. RESULTS: Approximately twothirds of the patients underwent surgery prior to tissue diagnosis.Eighty-nine patients had stage I and stage II disease, 8 and 81%,respectively. The patients underwent subtotal (44%) or total pleurectomy(56%). The surgical mortality rate was 1% (1/100) and the morbidity ratewas 22%. Morbidity included prolonged air leak (n = 12), empyema (n = 6),reaccumulation of pleural fluid (n = 2) and wound infection (n = 2).Palliative results included dyspnea and cough relief in all patients, chestrelief in 60 (85%) and pleural fluid control in 52 (96%) patients. Mediansurvival was 17 months in MPM patients. CONCLUSIONS: We conclude thatpleurectomy/decortication safely provides both tissue diagnosis andeffective of pleural effusion and symptoms and therefore excellentpalliation in patients with MPM.

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