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Page 4 of 12 Housman et al. J Cancer Metastasis Treat 2021;7:69 https://dx.doi.org/10.20517/2394-4722.2021.159

PLEURECTOMY/DECORTICATION
The pleurectomy was first reported as a palliative intervention for MPM in 1975 by Martini et al. in a
[25]
[26]
series of malignant pleural effusions. A year later, in 1976, Wanebo et al. published that patients
undergoing pleurectomy with chemotherapy and radiation for the epithelioid disease had a median survival
of 21 months.

In the years that followed, the P/D was viewed only as a cytoreductive alternative to the EPP in patients who
[27]
were not candidates for pneumonectomy . In the last several decades, P/D has been increasingly
investigated as the procedure of choice for mesothelioma. While many studies are conducted in the setting
of comparison with EPP, several noteworthy groups investigated P/D on their own.

[28]
A study by Bölükbas et al. studied 35 patients, 19 of whom had stage III and IV disease, who underwent
P/D followed by chemotherapy and radiation. A total of 33 patients (94.3%) completed trimodality therapy.
Overall median survival was 30.0 months with 1-year, 2-year, and 3-year survivals of 69%, 50%, and 31%,
respectively. The authors concluded that since the P/D better maintains postoperative physiologic reserve,
[28]
there is greater potential for multimodal options in the long term .
Lapidot et al. conducted a retrospective study of 355 consecutive patients undergoing P/D. MCR was
[29]
achieved in 304 patients (85.6%) with a median survival of 23.2 months vs. 11.6 months in the non-MCR
group. Median progression-free survival was 11.7 months. The 5-year survival in patients who had MCR
was 21.2% vs. 17.9%. The 30- and 90-day mortalities were 3.0% and 4.6%. The most common complications
were prolonged air leak (39.7%), deep vein thrombosis (18.0%), atrial fibrillation (11.8%), chylothorax
(6.8%), and empyema (6.5%) .
[29]
[27]
Marulli et al. conducted a review of 314 patients undergoing different forms of P/D in 11 Italian hospitals.
Of the total, 162 patients underwent extended P/D, 115 received P/D without pericardial or diaphragmatic
resection, and 37 underwent partial pleurectomy .
[27]
Neoadjuvant chemotherapy was given to 57% of patients, and adjuvant radiation was given to 39.2%.
Median overall survival was 23.0 months. The hazard ratios for extended P/D and P/D were similar at 0.46
and 0.52, respectively, and were both independent predictors of survival. Additionally, the authors also
noted that while partial pleurectomy was associated with a poor prognosis, R2 resection in the setting of
[27]
P/D had no impact on survival .

A recent study by Nakamura et al. investigated 90 patients who underwent neoadjuvant chemotherapy
[30]
followed by P/D. The 1-year and 3-year overall survival rates were 93.3% and 65.3%, with recurrence-free
[30]
survival of 19.0 months .
Sharkey et al. examined 300 patients who underwent P/D, 82 of whom were > 70 years old. Median
[31]
overall survival was similar for patients younger and older than 70 years, at 14 months and 10.3,
respectively. Older patients with positive nodes had poorer survival rates, but on multivariable analysis, age
[31]
was not independently associated with poorer outcomes .
In 2011, Teh et al. conducted a comprehensive review of lung-sparing extirpative surgery. Unsurprisingly,
[32]
substantial heterogeneity was found in both the nature of surgery, and the degree to which it was described.
From 26 papers and including 1270 patients, the authors present almost every conceivable variation on the
pleurectomy; including partial pleurectomy, total pleurectomy, complete pleurectomy, debulking, debulking