Malignant pleural mesothelioma: The role of surgery

Revue de Pneumologie Clinique 2018 October 10 [Link]

Fournel L1, Janet-Vendroux A2, Canny-Hamelin E2, Mansuet-Lupo A, Guinet C, Bobbio A, Damotte D, Alifano M


Malignant pleural mesothelioma (MPM) is a rare and highly aggressive disease, whose incidence is increasing. Asbestos is the primary causal agent.
Knowledge about MPM has evolved. Thoracoscopy is essential for diagnosis of MPM. It allows performing pleural biopsies, to study the extent of the disease and to relieve dyspnea. The pathological diagnosis is also better codified with immunohistochemistry and with analysis by expert of Mesopath group. Curative surgical treatments are pleurectomy decortication and extended pneumonectomy in combination with chemotherapy and/or radiotherapy. Those heavy treatments improve survival in highly selected patients. For the other patients, supportive measures will be considered to reduce pain and dyspnea.
Radical surgical treatment is only offered in therapeutic trials or multimodal treatment. Its place is not formally established. New therapies associated to surgical treatment are being studied.
Surgical management of MPM has to be operated in specialized teams where the survival benefit and quality of life is discussed case by case.